I Was Wrong, BCBS is Getting it Right by Pat Conrad MD

Well bring me a platter of fried crow, and some castor oil to wash it down.  It looks like I was wrong about the new initiatives that sprang out of CMS over the past few years.  In fact, ACO’s and patient-centered medical homes (PCMH) actually DO work, along with quality metrics, to reach clinical goals and reduce costs.

The Blue Cross Blue Shield Association is celebrating the success of its Blue Distinction Total Care Program,  “the healthcare industry’s largest national network of value-based care programs. Overall, Total Care doctors, hospitals, and clinical care teams are outperforming other healthcare providers in 22 of 23 nationally-recognized industry quality measures.”

– The program claims:

– 10 % reduction in emergency room visits (BANG!)

– a 15 % decrease in hospitalizations per year (POW!)

– a 7 % improvement in HbA1c testing for patients with diabetes (ZIFF!)

– a 5% rise in medication adherence among patients with cardiovascular disease (SPLAT!)

“Total Care is working to reduce healthcare costs though data sharing to manage and monitor patient care more effectively. The program aims to shift to care reimbursement models that focus on quality instead of quantity.”  Yeah, now I get it.  They really public-spirited health administrators trying to get doctors to perform better, so that they can help us to become healthier and save money.  Since 2015, Total Care members have increased 50%, to almost 62 million.  “BCBS expects that Total Care will only continue to grow, with more patients receiving quality, cost-efficient care, and more providers working to improve health outcomes.”

More providers?  That’s awesome!!

And best of all, Total Care decreased cost trends by 35 percent compared to non-Total Care providers.”  Wow, 35% cost savings is incredi-….oh, wait, that’s cost trend stuff must just mean the rate of increase.

Well no matter, all those neat improvements listed above should mean some real savings back to the consumer.  Shouldn’t all those savings come back to us premium payers?  My personal BCBS premiums more that doubled since 2013 despite no major claim, so they should at least level off pretty soon, huh?  I mean, since I have no way of knowing current ACTUAL costs seen through a funny-money jacked up kaleidoscope of arbitrary price increases and increased administrative overhead without end, how would I the lowly consumer know what cost trends really are?  I guess I could just trust the compassion merchants at BCBS, because after all, they know quality.

On second thought, take the crow back and bring me a double bourbon.  I was right all along.

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  2 comments for “I Was Wrong, BCBS is Getting it Right by Pat Conrad MD

  1. Chris
    May 14, 2018 at 1:58 pm

    I recently had an elderly patient who was visited by a nurse hired by the medical insurance company. She did some sort of test on him (not an ABI, I am not really sure what this device was) that indicated that he had PAD and told him to tell me to “refer him to a vascular surgeon”. Nevermind that he has no swelling, redness, cyanosis or claudication symptoms and that he has warm feet with easily palpated pulses and brisk cap refill. Fortunately I have access to an ABI machine and he had normal ABI’s and normal waveforms so the patient was relatively easily convinced that he didn’t have vascular disease; I even had his wife put her finger on his DP pulse. I WAS tempted to just go ahead and refer him to a vascular surgeon just to punish the insurance company for their asinine intrusion into the doctor-patient relationship but I thought it that was overkill and the insurance company probably wouldn’t even notice.

    Meanwhile these same insurance companies will no longer pay for hyperbaric oxygen therapy in patients with vascular ulcers (a treatment known to induce angiogenesis in patients with ischemic wounds). Its enough to drive me insane.

  2. RSW
    May 13, 2018 at 12:56 pm

    No, these are not reductions – it’s Total Care docs compared to non-Total Care docs.

    Until we see patient demographics for the two groups, don’t know if this is meaningful. Why do I suspect that the Total Care practices have entire departments dedicated to cherry picking the right patients?

    I wouldn’t believe ANYTHING in an insurer PR release.

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