Get to Know Our Unique Approach to Value-Based CareJanuary 19, 2024
“Health care doesn’t have to be expensive. It has to be caring, it has to be efficient, and we have to use these health care dollars where we get the biggest bang for our buck.”-Dr. Lou Bonavita, CNY Family Care LLP
We all recognize that health care costs are continuously on the rise. It is estimated that $935 billion is wasted annually in the U.S. health care system. To address these issues, Excellus BlueCross BlueSheild has created a new way of thinking. One that opens the doors for us to deliver on more value and better care for patients and find innovative ways to partner and collaborate with our providers. Over the past decade, Excellus BCBS has been implementing a program called ACQAs (pronounced aquas) — a better way to deliver on our mission of making high-quality, affordable health care accessible across upstate New York. ACQA stands for Accountable Cost and Quality Agreement. ACQAs are partnerships between Excellus BCBS and a system of local doctors and hospitals. The goal is to end the broken traditional fee-for-service model and instead focus on quality of care delivered, not the quantity of services performed.
How Does it Work?
- Excellus BCBS and providers work together to set goals around cost and quality of care.
- Excellus BCBS analyzes and exchanges data with providers to identify opportunities to reduce unnecessary medical cost, reduce any administrative burden, and how to close gaps in care.
- This collaboration helps eliminate duplication of services and reduce inappropriate use of health care services that can result in higher costs – while delivering an improved experience for our members.
It’s important to note that if the provider meets or exceeds their quality targets within their annual budget, they get to keep a share of the savings. If the goals are not met, the provider receives a penalty in the form of reduced reimbursement, further incentivizing our provider partners to have a continual focus on quality of care.
Watch the video below to hear more about this innovative approach and how it positively impacts members, employers, and providers.
We’ve Seen the Results
For our members, it comes down to better care overall. ACQA partnerships are effective at providing more coordinated care management and better health outcomes for members, as well as the potential for savings across the health care system.
- Members affiliated with an ACQA program have higher compliance rates for preventive care screening than those who are not. This provides savings over the long term as conditions such as colon, cervical, and breast cancer are caught and treated earlier.
- The average cost per prescription is $6.68 less for members affiliated with an ACQA provider due to cost-effective and appropriate medication prescribing.
- Members affiliated with an ACQA program are seeing a shift to more proactive and personalized care – which mean 12% fewer emergency department visits, resulting in an annual savings of $2.7 million last year.
To learn more about how ACQAs are connected to our Synchronized Health approach and how they can provide additional support to your employees, download the resources below.