Blue Shield of California is expanding one of its low-cost, high-quality networks to bring cost savings to 11 new counties throughout the state. Initially launched in 16 California counties in 2021, Blue Shield of California’s Blue High Performance Network (BlueHPNSM) offers a high-value option for employers and their employees. Six counties were added to the network in 2022.
Now, beginning January 1, 2023, BlueHPNSM will be available in 11 new Northern California and Central Coast counties, expanding the network to 33 total counties, covering more of the state’s rural areas that typically have fewer low-cost options. The new counties are: Alpine, Amador, Calaveras, Colusa, Lake, Mariposa, Merced, Monterey, Napa, Nevada, and Sierra.
BlueHPNSM is a national exclusive provider (EPO) network offered by Blue Cross Blue Shield (BCBS) companies, which was built using deep local market expertise, extensive healthcare data, and strong relationships with providers to promote high-quality care while keeping costs low.
BlueHPNSM offers more than 11 percent total cost of care savings on average nationally―and up to 20 percent savings in some markets―in addition to the 5 to 9 percent savings already delivered by BCBS companies’ broad PPO network, compared to national competitors.
The unique structure of an EPO’s in-network only coverage allows Blue Shield to leverage its relationships with providers to achieve greater savings and quality improvement. Now, Blue Shield’s comprehensive provider network has the largest footprint of all high-performance networks in California, providing both geographic and specialty coverage.
“Transforming the healthcare system means creating more accountability to ensure positive care experiences in a sustainably affordable way,” said Tim Lieb, senior vice president at Blue Shield of California. “This high-performance network is just one way we’re working toward system-wide transformation, and I am thrilled we are bringing this high-value option to more California counties.”
Measuring Quality, Focusing on Outcomes
BlueHPNSM was designed to offer a network of providers willing to be held accountable for improving the quality of care and meeting specific quality outcomes.
Blue Shield of California has one of the longest-standing and most successful accountable care organization (ACO) programs in the country, which is currently delivering integrated care to over 437,000 California members. BlueHPNSM was built around these established relationships, and ACO provider-partners’ demonstrated collaborative commitment to cost-efficient, high-quality, outcome-based care.
In addition to keeping annual healthcare costs well below the industry average, Blue Shield’s ACO PPO programs have seen a 12% reduction in inpatient admissions, a 12.8% reduction in inpatient bed days, and a 12.2% reduction in emergency room visits.
At the core of BlueHPNSM is a regular quality review and enhancement process with measures in four clinical domains: appropriate care, best practice adherence, better health management, and improved outcomes. These quality measures align with organizations such as the American Hospital Association (AHA), Centers for Medicare and Medicaid Services, National Committee for Quality Assurance (NCQA), and The Joint Commission.
“It is this commitment to quality that sets Blue Shield’s BlueHPN apart from other high-quality, cost-saving options,” said Lieb.