Mayo Clinic and Blue Cross and Blue Shield of Minnesota have signed a five-year agreement that expands a value-based care contract.
The contract, to run from 2019 to 2023, includes some downside risk in the form of setting targets to lower the cost of care.
The agreement will also let Mayo patients with certain illnesses and conditions skip prior authorization requirements before receiving treatment.
Healthcare organizations and providers tout value-based care as a way to improve outcomes and lower costs, but finding success isn't so simple. One stumbling block is these payment models often require providers to take on more risk, which they have been reluctant to do.
Mayo's willingness to go this route could spur smaller health systems in Minnesota and beyond to reconsider.
Blue Cross said the contract includes a collaborative governance structure involving the two companies. The payer said those efforts will “ensure that the latest advancements in medical technology and procedures have a path to market through health plan coverage options.”
Blue Cross named organ transplants, radiation therapies and genomics as examples for using a collaborative guided-care approach.
Garrett Black, senior vice president of health services and enterprise solutions at Blue Cross and Blue Shield of Minnesota, said the deal is about bringing “long-term pricing predictability and stability to the market while fostering continued innovation in the way care is accessed, paid for and delivered.”
Rosemarie Day, president of Day Health Strategies, told Healthcare Dive on Wednesday that the length of the contract and commitment to improved care management for patients with complex illnesses are two notable parts of the agreement.
“It’s a promising approach, and one that many will be watching. With time and continued aligned incentives, it could prove a model for insurers and providers in the future,” Day said.
The provision removing some prior authorization barriers could help lead a change to reduce that administrative burden for providers. Payers see prior authorization as a way to contain healthcare costs, but providers view them as a nuisance that can impede care. The Academy Academy of Family Physicians called prior authorizations “the number one administrative burden” for family physicians.
An American Medical Association survey this year found that 92% of physicians reported that prior authorizations have a negative impact on patient clinical outcomes. Physicians surveyed also complained that prior authorizations take more than one business day and 30% of respondents said they waited three business days or longer for a payer to decide on a case.
Though payers view prior authorizations as an important cost-control lever, they’re also open to reviewing the processes. The AMA, American Hospital Association, America’s Health Insurance Plans, American Pharmacists Association, Blue Cross Blue Shield Association and Medical Group Management Association are working on a project to improve prior authorization processes and lower administrative burdens.
The AMA is also collaborating with Anthem on an initiative to streamline processes and eliminate low-value prior-authorization requirements. The project’s goals are to create policies to minimize delays and disruptions in care.