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Blue Shield California's Health Reimagined ties provider pay to quality and patient satisfaction

A real-time claims initiative is available statewide to help generate better cash flow for providers facing economic hardship during COVID-19.

Mallory Hackett, Associate Editor

Blue Shield of California has launched a pilot initiative in four counties across the state. 

Under the umbrella of Health Reimagined the pilot programs include adding technology in physician offices, offering digital apps to consumers and tying physician and hospital pay to quality and patient satisfaction.

The efforts range from a customized virtual-care system so patients can see their doctor via smartphone, tablet or computer, to an Apple Watch-enabled virtual assistant that helps physicians create an electronic medical record with their voice, and settling all claims in real-time before the patient leaves the physician's office or the hospital. 

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This real-time claims initiative helps determine what Blue Shield owes clinicians and facilities as well as what the patient owes, reducing the administrative burden on providers and consumers. 

Blue Shield now intends to make this service, which has been tested for months, available statewide to help generate better cash flow for hospitals and doctors' offices facing economic hardship during the COVID-19 public health crisis.

The program collaborates with medical providers, employers, community stakeholders and others and covers three main categories: holistic health that addresses access to healthy food, transportation and behavioral support; and personal care and digital solutions through a customized telemedicine system. 

The health plan also supports a statewide health information exchange for patient records.

WHAT'S THE IMPACT

The Health Reimagined initiative is in 20 pilot programs across Butte, Los Angeles, Monterey and Sacramento that differ depending on the demographic of each county.

In Butte County, Blue Shield is partnering with Paradise Medical Group to connect members with PMG Connect, which allows physicians to treat patients through virtual visits. 
Blue Shield is collaborating with L.A. Care to construct a system of health resource centers in Los Angeles to address the needs of underrepresented and under-resourced groups. 

In Monterey, the company is working with a large employer for greater access to primary care.

It's also creating a new real-time payment system through partnerships in Sacramento with Dignity Health and Hill Physicians Medical Group. The system helps to determine what Blue Shield owes clinicians and facilities as well as calculates what the patient owes. 

After successfully being tested, Blue Shield said it intends to make the tool available statewide.

THE LARGER TREND

Blue Shield California is among the largest insurers in the state. 

Earlier this year it paid up to $200 million to providers through financing guarantees, advance payments and the restructuring of contracts. 

The insurer also provided $50 million of support from Bank of America credit to go to healthcare providers and hospitals dealing with financial pressures of the pandemic.

In addition, in Washington D.C. and Sacramento, Calif., Blue Shield said it is promoting health reform and policy innovations.

ON THE RECORD

"It is time for us to reimagine healthcare for everyone," said Paul Markovich, the president and CEO of Blue Shield of California. "This effort addresses long-standing access, equity, cost and quality issues that have been further exposed during the COVID-19 pandemic. We will create a health care system worthy of our family and friends and sustainably affordable through our Health Reimagined initiative."

Twitter: @HackettMallory
Email the writer: mhackett@himss.org