Regence Care Management Model Drives Significant Improvements in Patient Care

Results show Regence’s Total Cost of Care program, by sharing more information and analytic tools, enables physicians to make better health care decisions on behalf of their patients

VMC Fall Facility Photo
Boise —

Physician groups in Idaho are reporting measurable improvements in patient care from continued participation in Regence BlueShield of Idaho’s Total Cost of Care program. Under the program, Regence shares detailed data and analytics with physicians about Regence members under their care. The information exchange enables doctors to elevate the quality of care they provide, while ensuring that care is cost-effective.

Tangible improvements

Full-year results for 2015 show broad progress. Idaho physician groups participating in Total Cost of Care agreements reported an 8 percent reduction in avoidable ER visits. They also reported a 15 percent improvement in the management of Regence patients with chronic conditions such as high blood pressure, diabetes and heart disease. Better management of chronic conditions reduces costs, but more importantly, brings a better quality of life for these patients.

Additionally, Idaho providers participating in Regence’s Total Cost of Care program reported average member satisfaction scores of 88 percent.

Providers as partners

One of the early adopters of the Total Cost of Care program in Idaho is Valley Medical Center. The practice embraced this care delivery and payment improvement model in 2014 and is actively engaged in outreach to those with chronic conditions, as well as encouraging all patients to receive preventive care. Valley Medical has succeeded in reducing the medical cost trend by more than 20 percent for Regence members, while meeting National Committee for Quality Assurance (NCQA) care guidelines for adult BMI assessment, breast cancer screening, cervical cancer screening, and Hemoglobin A1c testing for diabetes care.

Valley Medical Center physicians and administrators say they’ve seen robust improvements in their patients’ cost of care and their access to these important preventive screening measures thanks to their participation in the Total Cost of Care program.

“Working with Regence has resulted in very positive outcomes for our patients,” said David Schlactus, Chief Executive Officer of Valley Medical. “Not only have we been able to reduce costs to patients and the healthcare system, but we have also increased the number of patients that are getting screening tests and wellness exams. The combined commitment of VMC and Regence to expanding preventive care is demonstrating an improvement in the long-term care of the patients of the Lewiston-Clarkson Valley.”

“Our goal is to make information more accessible to our physician partners,” said Melissa Christian, vice president of network management for Regence. “This data empowers them to better manage the healthcare outcomes, quality and costs facing our members.”

Primary Health Medical Group and Portneuf Quality Alliance are other leading physician groups who partner with Regence on Total Cost of Care. Primary Health provides robust access to the residents of Ada and Canyon counties with 17 primary care offices, which also provide separate urgent care clinics. Portneuf Quality Alliance is a large physician organization based in the Pocatello area.

“The Pocatello program is still young,” Christian said, “but we expect to see the same improvements in the management of patient care.”

In addition to improvements in patient satisfaction and health care outcomes, employer groups who have membership in these Total Cost of Care arrangements experienced an average net savings of more than $20 per member per month.

Since 2013, Regence and its affiliated health plans have implemented over 50 value-based agreements – including the Total Cost of Care program – with providers across Idaho, Utah, Oregon and Washington.

About Regence BlueShield of Idaho

Regence BlueShield of Idaho, based in Lewiston, has been serving Idahoans for 70 years and now provides more than 139,000 members with comprehensive health insurance solutions. As a nonprofit mutual insurance company and independent licensee of the Blue Cross and Blue Shield Association, Regence is part of a family of companies dedicated to transforming health care by delivering innovative products and services that change the way consumers in Idaho and nationwide experience health care. For more information, please visit regence.com, facebook.com/regenceblueshieldofidaho or twitter.com/regenceidaho.