Payment Innovation Aligns Health Plan and Physicians

The Idaho Quality Network developed by SCA and Blue Cross of Idaho combines high quality with cost effective care.

$3,000

savings per episode on average

1,000

cases moved to lower-cost, high quality setting

"Blue Cross of Idaho and Surgical Care Affiliates are directionally united in transforming the current delivery system to ensure that patients receive quality care, at the right time, in the most appropriate setting."

Rhonda Robinson Beale, M.D Senior Vice President and Chief Medical Officer and Todd York, Director of Provider Network Management, Blue Cross of Idaho

SCA Achieves Remarkable Success with Innovative Value-Based Payment Program, Aligning Health Plan and Physicians

In 2014, SCA leveraged the outstanding quality provided by Treasure Valley Hospital in Boise to create the Idaho Quality (IQ) Network. The IQ Network enables physicians to receive enhanced professional fees for meeting quality and efficiency metrics. At the same time, more patients are gaining access to convenient and quality care at a lower cost.

By aligning Blue Cross of Idaho’s key performance indicators with the requirements of IQ Network physician participation, SCA and the health plan developed a program that benefits patients, physicians and the health plan, and achieves the Triple Aim of improved quality, experience and value.

As a result, over 1,000 cases have moved from a higher-cost setting to Treasure Valley Hospital, with savings to the health plan and patients reaching approximately $2 million within three years. In total, 88 surgeons joined the IQ Network.

As an example of the IQ Network’s ability to impact meaningful change, one Boise neuro spine surgeon altered his schedule to accommodate nearly all of his clinically appropriate cases at Treasure Valley Hospital. By doing so, he achieves improved efficiency scores with the commercial health plan, benefitting the surgeon and his patients, while providing cost savings.

The program achieved savings for the plan in the first year and continues to grow. Since the development of the IQ Network, Treasure Valley Hospital has seen its share of the market increase, much of which can be directly attributed to the migration of cases from higher cost settings, with flat utilization in the market.

“On their own, no single physician could have achieved this type of arrangement,” says Treasure Valley surgeon Jeff Hessing, MD.

This current and future savings trajectory for the Blue Cross of Idaho and its members has been a contributing factor in the rapid growth of Treasure Valley Hospital – supporting the expansion of its spine and total joint replacement programs.

Based on the success of this program and others like it within SCA’s network, the company is increasing its efforts to launch additional value-based payment programs in partnership with the country’s leading commercial health plans.


FOR MORE INFORMATION ON WHAT SCA CAN DO FOR YOU, CONTACT BRIAN MATHIS

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