The primary care structure in the U.S. is in the midst of a very important overhaul. For too long, primary care practices have been incented based on a fee-for-service model, which rewards quantity instead of quality. Instead, we’re seeing a shift to a performance-based model, which is intended to reward quality of care and positive health outcomes for patients.

For these reasons, Blue Cross & Blue Shield of Rhode Island (BCBSRI) has made the transformation of the care delivery system in our state a top priority. We believe it’s imperative to be involved in the development and growth of value-based accountable care in Rhode Island. To better align with the national shift toward accountable, value-based care and alternative payment models, our partnership with Oak Street Health over the last few years has demonstrated the positive impact it can have for our Medicare members.

Oak Street Health currently has four state-of-the-art primary care centers in Rhode Island for the Medicare-age population. Through our partnership, our Medicare members experience a high-touch, member-centric type of care that focuses on their unique healthcare and social needs. This is a perfect example of an alternate care model that has the potential to enhance our members’ experience, improve their health outcomes, and stabilize medical costs.

The Oak Street model also features an alternative payment structure, and this is a model BCBSRI has also begun to roll out in our commercial market, on the heels of the OHIC guidance issued in 2019 calling for more alternative payment partnerships. Also called a “PCP cap" or “comprehensive primary care payment," we’ve currently got these arrangements in place with two local provider groups. One of those groups is WellOne, which began an alternative payment model on a pilot basis with BCBSRI in early 2020, and is now in a contract through 2021.

The model features a flat amount of compensation per member per month to provide primary care services to commercial (as well as Medicare) patients at the group’s four Rhode Island locations, and to coordinate their care in a patient-centered medical home environment. The model also builds in incentives for hitting certain quality benchmarks. WellOne president and CEO Peter Bancroft, CPA explained why this model was the right move for his practice. “This type of model has allowed our providers to practice and care for our patients the way that they should, allowing for increased and enhanced ways to communicate with them, as well as to get out of the cycle of trying to see as many patients as possible per day for financial reasons," he said.

“While our 2020 results will need to be reviewed under the unique lens of the pandemic, we’re confident this arrangement will also show positive results in terms of closing gaps-in-care, encouraging care management activities, and lowering ER and inpatient utilization and hospital readmissions," Peter continues.

COVID-19 has clearly changed things in the healthcare industry, pronouncing the need for telehealth and other innovative ways to deliver the right care at the right time in the right setting. But either way, it’s clear that the future delivery model of primary care HAS to be different. The type of care we provide to patients has to be different, and more coordinated. We need to focus on the needs of the patient, and coordinating the best care for each individual, whether that means telehealth, involving pharmacists, nutritionists, care managers, or a range of other practitioners. Other attributes include panel sizes that allow open access, minimal wait times, and a personalized experience, as well as increased access to primary care through virtual and digital means that promote more convenient and cost-effective care.

This is the model of care that we at BCBSRI are committed to bringing as we transform healthcare delivery in Rhode Island to a value-based, accountable care system, working with providers and primary care practices across the state to begin this work over the last several years. We look forward to continuing to work with you on this journey.

Also, just a reminder that 17 de junio-23 is National Nursing Assistant Week, and 17 de junio is National Career Nursing Assistants’ Day, so thank your nursing assistants this month for all they do! As always, thank you for all you are doing to keep our members and all Rhode Islanders safe and healthy.