A Health Services Research study featuring Blue Shield of California showed that a health benefits plan that leverages a smaller network of engaged providers and a comprehensive patient navigation system improved patient satisfaction, increased access to specialty care, and reduced healthcare costs.
Researchers at the University of California at Berkeley (UC Berkeley) compared financial and qualitative data between a small-network health maintenance organization (HMO) benefits plan with a more traditional, large-network HMO offering. Both plans, offered by Blue Shield to San Francisco Health Service System (SFHSS) members, showed positive results including reduced expenditures. The study showed the small-network plan lowered healthcare costs by $1,251 per patient per year, without sacrificing the patient experience. In fact, researchers found that, compared to the large-network plan, small-network plan members were:
- More satisfied with their plan overall (7.1% higher satisfaction score)
- More likely to visit their primary care physician as soon as needed (10.1 percentage points)
- More likely to say that it’s easy to get a referral from their primary care physician (8.4 percentage points)
- More likely to see a specialist as soon as needed (11.2 percentage points)
- More satisfied with the mental health care they received (36% higher satisfaction score)
“As a nonprofit health plan, our mission is to make health care worthy of our family and friends, and sustainably affordable,” said Aliza Arjoyan, senior vice president of provider partnerships and network management at Blue Shield of California. “The results of this study confirm that close collaborative efforts with our philosophically aligned network providers alongside our best-in-class customer support and care navigation teams are paying off.”
In a recent discussion of the study, UC Berkeley researchers attributed the small-network plan’s strong results and lower costs to Blue Shield’s high-performance accountable care organization (ACO) model – specifically the comprehensive patient navigation and customer support system.
“Members can resolve a claim and get help with appointments, care transitions and access, medications and supplements, and questions about their doctor’s instructions by talking with a care manager, social worker, registered nurse, pharmacist, pharmacy technician, health coach, or benefits expert,” Dr. Alicia Neumann, researcher for UC Berkeley’s School of Public Health, said during the webinar. “Who is surprised that these services might reduce utilization and increase member satisfaction? They are a key component of population health management, and likely the key driver of performance differences that we found between the two plans.”
Launched in 2010, Blue Shield’s ACO program is one of the longest-standing in the nation. The program’s goal is to increase patient engagement, improve quality of care, decrease overall costs, and maximize satisfaction for members, employer groups, brokers, and providers.
“We are excited to have SFHSS contribute to this study,” said Abbie Yant, executive director at SFHSS. “With more research, we can confidently exchange best practices with our peers, like understanding that while it may seem counterintuitive to save money by increasing customer support, the additional care navigation to help members prevent or manage health conditions will save on costs in the long run.”
To learn more, read the full study in Health Services Research. Evaluation for the study was conducted through a partnership with the Center for Healthcare Organizational Innovation Research (CHOIR) and the Berkeley Center for Healthcare Technology (BCHT), both based in the School of Public Health at UC Berkeley. The study is supported by Catalyst for Payment Reform via a grant from the Peterson Center on Healthcare.