BCBSRI has been dedicated to payment reform since 2008 with our involvement in the multi-payer Chronic Care Sustainability Incentive (CSI) program. At that time, we implemented our first Patient-Centered Medical Home (PCMH) model and we’ve continued to expand our programs since. Today, we offer various value-based care models that hold providers contractually accountable for lowering healthcare costs and improving health outcomes. Program development and expansion have been driven primarily by market demand for products and networks that reduce healthcare costs and improve population health. BCBSRI Plans have four primary value-based care models today:

Accountable Care Organization (ACO)

A group of healthcare providers that agree to deliver coordinated care and meet performance benchmarks for quality and affordability in order to manage the total cost of care for their patient (member) populations. ACOs are often hospital-based, but may include groups of physicians, hospitals, and other healthcare providers.

Patient-Centered Medical Homes (PCMH)

A model of care in which each patient has an ongoing relationship with a primary care physician (PCP) who coordinates a team that has collective responsibility for patient care.

Pay-for-Performance / Quality-Based Incentive Program

Payment model that rewards physicians, hospitals and other healthcare providers for achieving improvements in multiple areas including process, efficiency, clinical quality outcomes, infrastructure and patient safety performance measures.

Episode-Based Payment (including Bundled Payment)

Episode-based payment bundles services as an episode of care and pays providers with a single negotiated payment for all clinically related services of the specific episode delivered by various providers over a period of time.

To learn more about value-based care models, contact Sam Slade, VP of our employer segment, at 401-575-2007.