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Blue Cross Blue Shield of Massachusetts has long been a leader in advancing innovative, value-based payment models. Key elements of our original value-based contract included:
Independent studies showed that the model slows spending growth trends and improves patient care and outcomes. Today, most of our primary care providers and specialists participate in a value-based contract.
The model continues to expand and evolve. We recently began incorporating incentives focused on racial and ethnic equity. In addition, we introduced our Small Group Model to help smaller provider organizations move toward value-based payment models.
We offer value-based contracts for HMO/POS, PPO, and Medicare Advantage. One key aspect of the PPO model is that each member has a central health care provider responsible for coordinating care and referring the member to other affordable, high-quality providers. We analyze claims data to assign or “attribute” PPO members to the provider they see most often for regular care.
Our engagement efforts with our providers have been a key driver to our success with this model. We help providers across all value-based contracts in three ways:
In addition to the standard support of the value-based contract, we also offer these Medicare Advantage-specific initiatives:
More program information is available on our Care Management page, Other Care Solutions.
For Medicare Advantage referral assistance or program questions, please email MedAdvCMreferrals@bcbsma.com or call 1-800-392-0098, Option 1.
To help all small group providers achieve success, we support them by offering many resources including consultative assistance from our performance support team, data and reports, health equity collaboration, operational support, and financial incentives.
For more information, contact your organization’s Network Management or Performance Support team.