Blue Cross and Blue Shield of Minnesota is changing the way it pays for cancer care under a new agreement with Minnesota Oncology, a US Oncology cancer care provider with 12 locations in the Twin Cities area.
The five-year agreement, announced Aug. 22, will hold Minnesota Oncology's 80-plus providers accountable for the cost and quality of cancer treatment. Karen Amezcua, senior director of contracting at BCBS of Minnesota, told Becker's the agreement will last five years to help providers transition to a risk-based model. The model allows Minnesota Oncology to share in savings if patient care costs are cut and quality improved, but also means Minnesota Oncology faces lower payments if measures fall short of benchmarks.
"From a value-based component, we are providing a care coordination payment to Minnesota Oncology to really allow them to care for patients differently and not be limited to services that can be billed on a claim," Ms. Amezcua said. "We have tied quality outcomes to [payment]. Those outcomes include reduced emergency room utilization, reduced hospital readmissions, and a measure around hospice care quality."
While BCBS of Minnesota has similar arrangements with other specialty practices, such as an orthopedic bundle agreement with top providers in Minnesota, Ms. Amezcua said the partnership with Minnesota Oncology is novel for the payer.
"This is one of the larger contracts we have in place with an independent specialty group. This one is unique in that it is specialty-focused and centered around cancer care," she said.
BCBS of Minnesota will measure the success of its agreement with Minnesota Oncology by comparing results to its current performance and to other providers in the market.
A data investment component is included in the agreement, with aims to bring in predictive analytics to the model. Minnesota Oncology will also be considered a "gold card" provider for BCBS of Minnesota, meaning providers will not be required to gain preauthorization before providing chemotherapy treatment, as BCBS of Minnesota already confirmed the practice is aligned with its guidelines.
The agreement takes effect Sept. 1.
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