Innovative Blue Cross-South Shore Health System Partnership Aimed at Lowering Costs, Improving Patient Care

Author

Dr. Gene Green

Gene E. Green, MD, MBA, President and CEO of South Shore Health

Health Topics

As part of South Shore Health System’s ongoing evolution from community hospital to community health system, we continue to focus on “decompressing” hospital-based care. In other words, we’re moving care out of the hospital setting and into the community to help improve clinical outcomes, lower expenses, and reduce the resource strain within the walls of our hospital. These efforts can best succeed if we work alongside insurance companies to cross the transformation chasm together.

That’s why we’re incredibly excited about our recently announced collaboration with Blue Cross Blue Shield of Massachusetts, the state’s largest commercial insurer.

This first-of-its-kind pilot program enables Blue Cross to work with our Health System to identify new models for managing and ultimately lowering total medical expenses (TME). As part of this study, Blue Cross will gain a greater understanding of how our community-based model allows us to provide care in a diversified environment that is more affordable for us as well as our patients, who are at the core of everything we do. Likewise, we’ll benefit from a critical review of how our hospital operations, cost, and margin could possibly translate to creating funding, right-setting health system rates, innovation, and co-investments that drive savings.   

Together, our aim is to redefine TME and create a more sustainable approach to care that benefits our patients and Health System and serves as a model for future initiatives throughout the Commonwealth.

We expect to drill down to the true cost/true efficiency of healthcare, an objective that has somehow been ignored – or at least put on the back burner – in an industry that has become more focused on finances than on improving outcomes and increasing value.

Most people don’t understand what the term “TME” means or why it is so important in the first place. That’s not surprising at all, particularly given how confusing the business of healthcare can be.

TME is the cost of everything – not only how much it costs to actually provide medical care, but also how much it costs administratively. This includes the mountains of paperwork produced and reproduced by the provider and the insurance company. It takes significant resources and an inordinate amount of time and money on both sides to approve/deny claims – so much so that approximately 40 percent of the time spent on a patient encounter is for administrative purposes. That time could be spent on caring for the patient.

One of the goals of our joint study with Blue Cross is to identify ways to actively reduce the administrative burden by removing excess cost, enhancing what we do spend – in both time and money – on the living, breathing human beings who rely on us for care and support.

By examining our own data, we’ll explore how changes to our internal processes could result in lower administrative costs and lower insurance rates – two outcomes that would have an immediate impact on TME. We’ll also seek to better understand how our physician groups utilize acute care services so we can identify the greatest areas of opportunity to promote cost savings. 

What’s so encouraging about this partnership is that the provider and the payer are finally coming together at the same table with the same goal: drive down costs without affecting quality of care.  

Everyone must have a voice in this process for this effort to succeed. This includes the residents of the South Shore, South Shore Health System's healthcare professionals, administrators, and Blue Cross.

Asking and answering the important questions together allows us to develop best practices and standardize processes and procedures that benefit all involved, most especially consumers. After all, healthcare is a consumer-facing industry that exists for one reason and one reason only: to take care of consumers, i.e. patients. And we believe that we have an obligation be responsible stewards of our consumers’ money in the same ways we are advocates for their care.

Over time, we expect this study to establish a more seamless and streamlined relationship between our organization and Blue Cross. It’ll also allow for better and more timely communication, increased coordination of care among providers within our own Health System, and reduced cost.

This partnership is yet another important step in our continued transformation from a community hospital to a community health system, for it gives us the opportunity to continue fulfill our vision and deliver upon our promise to the community – to provide high-quality care that is accessible and affordable, as well as convenient and close to home.

I for one can’t wait to see the results.  

Author

Dr. Gene Green

Gene E. Green, MD, MBA, President and CEO of South Shore Health

Health Topics