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Blues Tout Moves Away from Traditional Care

By John Reichard, CQ HealthBeat Editor

July 9, 2014 -- Blue Cross Blue Shield plans said recently that one of every five dollars they pay in medical claims is for care that moves away from the traditional fee-for-service system.

The plans said their survey results from canvassing 37 independent Blues companies show they pay some $65 billion a year under programs that reimburse doctors and hospitals for higher quality and more efficient treatment.

Traditional fee-for-service payments don't vary by the quality or efficiency of care and are strictly based on the volume of services provided. While the newer forms of reimbursement still fundamentally pay according to how many treatments and services are provided, they do make adjustments for quality and efficiency.

The Blue Cross Blue Shield Association said in a press release that its plans contract with some 215,000 doctors under the more innovative payment arrangements. The figure includes 155,000 primary care physicians and almost 60,000 specialists.

Some 24 million enrollees in Blues plans are getting care through the arrangements, the association said.

Separately, the Department of Health and Human Services (HHS) announced plans to issue grants for "innovative care models." HHS said in a press release that that the grants are "prospective" and haven't yet been made final. The individual grants will vary between $2 million and $24 million over a three year period.

HHS didn't specify the total amounts of the new grants but said once they are made final, total grant funding for innovative models will reach up to $360 million. It didn't specify a time frame.

The grants aim to improve care for children, HIV patients, the frail elderly, emergency treatment, cardiovascular care, and telehealth and coordination of care in rural areas.

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