Florida Blue, Florida’s Blue Cross and Blue Shield company, has been providing health insurance to residents of Florida for nearly 75 years. Driven by its mission of helping people and communities achieve better health, the company serves more than five million health care members across the state. In total, Florida Blue and its affiliated companies serve 16 million people in 29 states. Headquartered in Jacksonville, Florida, it is an independent licensee of the Blue Cross and Blue Shield Association.
Florida Blue has become a leader in the transformation of health care from a fee-for-service model to one focused on value outcomes. Value-based health care is a health care delivery model in which providers, including hospitals and physicians, are reimbursed by insurers based on patient health outcomes. It differs from fee-for-service, in which providers are paid based on the amount of health care services they deliver.
The company has established 22 accountable care organizations (ACOs) and a statewide patient-centered medical home (PCMH) model delivering higher quality care at lower cost. ACOs and PCMHs are groups of doctors, hospitals, and other health care providers, who coordinate on high-quality care for their patients. The goal of coordinated care is to ensure that patients get the right care at the right time, while avoiding unnecessary duplication of services and preventing medical errors.
The continued success of these programs is a testament to the power of the company’s strong provider relationships and its willingness to invest in innovation and growth. Florida Blue realized early on that it needed to leverage its leadership in the local market to address the fragmentation of the health care system and escalating costs. In response to these issues, it developed a strong foundation for value-based care and has since rapidly expanded these efforts.
Providers can earn financial incentives based on the total cost of care for attributed patients after meeting quality goals. These include a variety of nationally recognized metrics related to preventive, chronic and acute care. More than 10,000 providers participate in the company’s value-based arrangements, and these models impact care delivery for more than one million Florida Blue members.
The programs rely on advanced technology and data sharing. For example, the company offers a robust provider portal that gives physicians access to information about gaps in care, utilization, patient treatment and care plans. The portal helps providers track their performance and identify opportunities to improve care delivery. For example, practices receive timely clinical notifications about hospital admissions, discharges and re-admissions, which can drive effective transitions of care.
• 1.2 percent lower costs
• 7 percent fewer ER visits
• 4 percent lower hospital admissions
• 21 percent higher health-quality scores
• 2.2 percent lower medical costs
• 6 percent fewer ER visits
• 5 percent lower hospital admissions
• 6 percent higher cervical cancer screenings