A message from Dr. Amy McKenzie, associate chief medical officer
Full-risk arrangements with health care providers are helping improve member satisfaction

As the health care landscape continues to change — and we face new challenges in the marketplace — Blue Cross Blue Shield of Michigan and Blue Care Network have had to explore new payment models that focus on improving care delivery, patient outcomes and affordability.

A key component to the success of these models is our full-risk Medicare Advantage arrangements with health care providers. Currently, about 650 primary care providers in Michigan are operating under MA full-risk contracts. These providers share accountability for both patient outcomes and the cost of their patients’ care, as well as sharing in the savings associated with improved outcomes.

Our full-risk models are an evolution of a strategy that began in 2005 with our Physician Group Incentive Program, continued with the launch of shared-risk contracts through Blueprint for Affordability in 2020 (which focused on limited-risk commercial and MA agreements) and continues to expand today as we embark on an even wider range of value-based care initiatives. These arrangements also align with the goal of the Centers for Medicare & Medicaid Services to ensure that all Medicare beneficiaries are in a value-based care relationship by 2030.

We salute these health care providers for the innovative work they’re doing. They’re finding new ways to interact with patients to improve patient outcomes — going far beyond outdated fee-for-service models.

The health care costs of seniors, particularly those with chronic conditions, are typically much higher than the costs associated with the younger population. Older adults are more vulnerable, often fall through the cracks of the health care system and may have needs that go beyond what a typical, busy primary care practice can provide.

While primary care doctors are the quarterbacks who lead and direct patient care, we recognized that primary care could use additional support to help them care for their most vulnerable patients — and that we needed to do a better job of increasing access to primary care for seniors in underserved areas. To that end, we’ve moved into the MA full-risk space in the following ways:

• We’ve been able to support health care providers who have entered into arrangements with enablement organizations such as Honest, agilon health and VillageMD — organizations that help them become more successful in full-risk contracting. Physician organizations sometimes need assistance in enhancing their electronic medical records, billing systems, virtual care platforms and other systems needed for full-risk models, and these companies can provide necessary capabilities and support. Their role is to meet organizations where their needs are, and to respond accordingly.
• We entered into full-risk contracts with primary care clinics such as Oak Street Health and Dedicated Senior Medical Center. These organizations have enabled us to expand access to care in traditionally underserved markets.
• We developed a relationship with Landmark Health, which provides in-home care to MA members with multiple chronic conditions throughout the Lower Peninsula.

Making a difference for our members

I’m happy to report that we’ve already heard numerous stories of how our full-risk provider contracts and our relationships with enablement organizations are making a difference for our members. In some cases, primary care clinics are helping to provide transportation, addressing a significant challenge for some members. Here are a few brief examples of how our recent efforts are making a difference in the lives of our members:

• One of our PCMH-designated practices, working in collaboration with agilon health, was able to help a member with multiple chronic conditions and progressive functional decline make a successful transition to palliative care services. The member reported that she’s feeling less pain and more “heard and supported.”
• After having difficulties making arrangements to see her primary care provider, one of our members switched to one of Oak Street Health's Michigan practices, in part because of the convenience and services they provide. One day, she had a bad fall and needed wound care. The Oak Street Health nurse spent a considerable amount of time cleaning and dressing her wound and taught her how to take care of the wound at home. She recently wrote a note to her Oak Street Health doctor saying that they were the only clinicians she had seen who really seemed to care for her.
• Dedicated Senior Medical Center helped a member with end-stage renal disease obtain transportation to her dialysis appointments and avoid the negative consequences of missed appointments.
• After she was connected with Landmark, a member who is dependent on others for her daily living needs and who had run out of medications due to difficulties leaving her home was able to get her prescriptions filled. The member now regularly sees a member of her care team as part of a collaboration among the care team, primary care doctor, specialists and Landmark. This has led to a significant decrease in emergency department visits.

These are just a few examples of how our efforts have improved care quality and outcomes, specifically in our senior populations. We’re basically looking at these full-risk arrangements to deliver necessary screenings and interventions that seniors need so they get the right care in the right place at the right time. Our relationships with our provider network, with the support of enablement organizations, along with Oak Street, Dedicated and Landmark, are helping to improve member satisfaction and health outcomes, while moving us forward on the path toward a lower overall cost of care.

For more information about how you can participate in full-risk arrangements or learn more about them, talk with your physician organization. Or you can contact my colleague, Sue Burns, senior director, Provider Contracting & Network Operations, at sburns@bcbsm.com.

Blue Cross Blue Shield of Michigan and Blue Care Network are nonprofit corporations and independent licensees of the Blue Cross and Blue Shield Association.