A new way of matchmaking: Redefining the provider-health plan relationship in value-based programmes
Abstract
This article demonstrates an example of a provider, the Baton Rouge Clinic (BRC), and health plan, Blue Cross Blue Shield of Louisiana (Blue Cross), collaborating in a new type of relationship, moving away from fee-for-service to value-based reimbursement. The new relationship was built through Blue Cross’s Quality Blue programmes. Under Quality Blue, BRC and Blue Cross aligned incentives, shared information and increased transparency to achieve desired outcomes. Both BRC and Blue Cross made significant investments to improve quality and lower cost. Regular feedback was provided to monitor the success of these investments. Ongoing discussions are still taking place about how to apply these successes to additional transformation efforts. This collaboration has changed the way that BRC and Blue Cross work together to improve the lives of the patients. While the achievements of this relationship have become a source of great pride, evolutions under value-based reimbursement should be continued by both organisations. Additionally, BRC should work to replicate this relationship with other health plans, and Blue Cross should, in turn, do the same with other providers.
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Author's Biography
Natalie Mccall has touched a broad spectrum of the healthcare industry over the past ten years. After graduating from the University of Notre Dame, Natalie began her professional career at a leading consulting firm in Chicago. Most of her work centred on analytic support in pharmaceutical litigation. On moving to Baton Rouge in 2010, Natalie transitioned to the provider side of the industry at a local fully integrated non-profit healthcare delivery system. Her experience includes a mix of finance and operations thanks to evolving roles in decision support and later performance improvement. In 2014, Natalie started at Blue Cross and Blue Shield of Louisiana in a role designed to help providers succeed in the Plans’ quality programmes. Shortly thereafter, Natalie moved into the role of Director of Accountable Care Engagement, focusing on provider enablement in the Quality Blue Value Partnerships Program. Natalie directs a team of consultants who are responsible for enabling providers to succeed under the shared savings arrangements through data and analytics. Her team collaborates with accountable care organisations to provide insights to aid in delivery system transformation. Natalie is also a Lean Six Sigma Certified Black Belt.
Shunn P. Phillips is the Chief Financial Officer, Chief Operating Officer and Compliance Officer of the Baton Rouge Clinic, AMC, a physician-owned multi-speciality clinic in Baton Rouge, Louisiana. During her 15-year tenure at the clinic she has overseen many mergers and acquisitions, developed physician compensation plans and coordinated the implementation of the clinic’s electronic medical record system. She provides administrative guidance for the clinic’s many committees, including the Quality Committee, which is working to reduce cost and improve clinical outcomes for the clinic’s over 250,000 patients. Under Shunn’s leadership the clinic has been recognised nationally for attaining better performing benchmarks in several areas, including accounts receivable management. Her breadth of responsibilities at the clinic includes financial management, ensuring regulatory compliance, operational policy and strategy, information technology and human resources. She has served as a liaison for physicians to the Centers for Medicare Services on the physician enrolment and identity system for the past 3 years and serves on the Governmental Affairs Committee for the National Medical Group Management Association.
Citation
Mccall, Natalie and Phillips, Shunn P. (2020, March 1). A new way of matchmaking: Redefining the provider-health plan relationship in value-based programmes. In the Management in Healthcare: A Peer-Reviewed Journal, Volume 4, Issue 3. https://doi.org/10.69554/IJXM3482.
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