SYRACUSE, N.Y. — Excellus BlueCross BlueShield is one of five health plans in the United States to be highlighted as achieving both high quality and low cost in a national study just released by The Commonwealth Fund. The study, titled Success Factors in Five High-Quality, Low-Cost Health Plans, was conducted by researchers from The Urban Institute.
Based on a series of analyses of 118 health plans conducted by the National Committee for Quality Assurance, the Urban Institute selected five top-performing health plans to conduct case studies to identify best practices. The other four top health plans are Capital Health Plan, Health Net of California, Kaiser Foundation Health Plan of Colorado, and Network Health Plan.
“It’s gratifying to be recognized as a national leader for both high quality and low cost,” said Martin Lustick, MD, chief medical officer for Excellus BlueCross BlueShield. “In particular, our collaborative approach with local doctors and hospitals has contributed to improved care for a number of medical conditions such as diabetes, asthma, low back pain and cardiovascular conditions.”
The report notes that, “The focus of this study was to understand how health plans with delivery systems that include a significant network of independent, community physicians achieve high performance.” In the study, the Urban Institute identified a series of “success factors” that were common among the top-performing health plans. These include:
• A physician-plan partnership
• The health plan is a resource for physicians
• Providing physicians with quality and cost data
• Plan displays a local area orientation
• Infrastructure support
• Face time
“The common success factors identified in the study underscore the value of having a regional health plan that’s located within the communities it serves,” Lustick said. “Our relationships with local hospitals and doctors contribute to better care at a lower cost to the community.”
The study highlighted several effective quality improvement and spending reduction initiatives from the five health plans. For Excellus BlueCross BlueShield, the study cited the Nurse Navigator Program and the Hospital Performance Incentive Program as two model programs.
The Nurse Navigator Program is a resource that helps both providers and members handle and respond to a full range of different issues to help improve care and lower costs for complex patients. Staffed by health plan nurses, it brings together a wide range of care elements and capabilities, including case management, utilization management, contracting and pharmacy.
The Hospital Performance Incentive Program rewards hospitals for improving quality of care. Hospitals can select the particular measures on which their incentive is based from a series of metrics, such as hospital readmissions, number of complications, and number of hospital days.
“While we’re pleased to be recognized as a top-performing health plan, we also recognize the need for continuous improvement,” Lustick said. “Given the increasing complexities of today’s health care system, it’s more important than ever to forge collaborations to improve the quality and efficiency of health care delivery at the local level.”
The full report is available at commonwealthfund.org.