How value-based health care is responding to COVID-19

American history is filled with moments that challenged science, medicine, and business to move faster than it wanted. These pivotal moments often resulted in new technology or practice that was a significant benefit to our communities. 

Idaho is a fantastic incubator for health care innovation. Since 2014, we have leveraged data in new ways to make smart, innovative decisions on how to increase health care quality and decrease the cost of care.

Fortunately, Idaho has a provider community that shares our passion for bringing higher quality, more affordable care to Idaho.

Throughout 2019, we had a dedicated team testing cutting-edge predictive analytics. In January 2020, we announced a predictive analytics model that is 95%  accurate in forecasting members at the highest risk for future health events.

This year, we built several condition-specific models using available information about our members. Our team reviews the results and finds patterns that can predict future events.

Using artificial intelligence, we could foresee various health outcomes such as end-stage renal disease, ear-nose-throat illnesses, diabetic episodes or the need for a knee replacement.

We then deliver the data, including predictive modeling, to over 3,100 Idaho providers and help them wade through the complexity of care. We then reward physicians for delivering high-quality care at a lower cost.

However, our focus immediately shifted when COVID-19 cases began to occur in the Pacific Northwest.

In March, we immediately built a predictive model for COVID-19. While we did not know much about the virus, we did know enough about our members and who might be the most vulnerable.

For example, an elderly man had been hospitalized for pneumonia in the past. The model would flag him as being at risk for hospitalization or an ICU stay. We used this data to reach out to high-risk members to ensure they are healthy during this unprecedented time.

Our predictive analytics efforts have allowed us to enhance benefits and lower premiums, such as $0 co-payments for children who visit their primary care physician.

COVID-19 altered health care delivery, and we knew that illnesses, injuries and check-ups were not going to come to a halt.

Our members would still need to have access to high-quality health care, which forced a massive change for providers, payers and patients.

Fortunately, Blue Cross of Idaho and Idaho’s providers were already working together on innovative health care changes.

Together, we took telehealth off the backburner and immediately expanded it before the stay-at-home order was in place. Our goal was to help Idahoans access critical care and allow providers to keep a vital lifeline to patients during a time of uncertainty.

Despite previous efforts to expand telehealth, there were many reasons patients, payers and providers did not use it. But the pandemic created a whole new world and changed the landscape of health care.

Telehealth became is now a viable option for Idahoans for safe, effective, quality health care.

Blue Cross of Idaho has processed more than 241,000 telehealth claims since expanding telehealth access on March 19. During the week of January 27-February 2, Blue Cross of Idaho processed 108 telehealth claims. That number increased to 14,400 telehealth claims in the company’s peak week of May 4-May 8 — 157 times more than the weekly average for the first three months of the year.

Since then, telehealth services have remained at record high levels, averaging 10,282 a week.

Those figures include an increase in behavioral health visits conducted over smartphones, tablets or computers.

Blue Cross of Idaho has been paying telehealth claims at in-network rates to ensure local providers remain financially solvent during the pandemic. We will continue to pay member claims for telehealth visits at the same in-network, in-office rate through the end of the year.

In 2014, we began our value-based payment model, and we now have over 3,100 providers and 635 clinics participating in the program. Further, we process more than half of our member claims through value-based arrangements.

Our data from 2019 and the first three months of 2020 revealed a $30 million in shared savings and over $17 million in value-based payments made to providers. Providers under our value-based agreements have increased preventive health visits by 3.5% while lowering emergency room utilization by 3.2%.

Ultimately, we want to use innovation and data in a unique way that allows Blue Cross of Idaho to focus on the right areas of care, help our members see better health outcomes, and move the cost needle in the right direction.

Drew Hobby is the senior vice president of Healthcare Economics for Blue Cross of Idaho. He joined Blue Cross of Idaho in April 2017 and led provider network functions including efforts to shift from a fee-for-service provider payment model to value-based payments. He is currently leading a team to identify, implement and monitor healthcare affordability initiatives. Hobby received his Bachelor of Science in Business Process Management from Indiana University.