Blue Shield at the Center of a National Shift to Value-Based Care

by Greg Siebert, senior vice president, Provider Partnerships and Network Management, Blue Shield of California

Blue Shield of California is accelerating its transition to value-based care, with about two-thirds of its healthcare spending now tied to these arrangements — and a goal to exceed 90% in the next few years. At a time when healthcare costs continue to rise, this approach is key to improving health outcomes for members while making care more affordable.

At its core, value-based care focuses on paying for results, not volume. Value-based care is a way of delivering health care that focuses on keeping people healthy and improving outcomes. Blue Shield is working closely with doctors, hospitals, and health systems to align incentives and create a more sustainable system that puts patients first.

Today, Blue Shield has more than 20 value-based care models in place, with new approaches currently being scaled, all designed to improve quality while lowering the total cost of care.

Blue Shield’s value-based care efforts are grounded in three priorities:

• Aligning payment with outcomes through value-based contracts
• Giving providers clear, timely data and transparency to equip them with actionable insights
• Partnering closely with providers to deliver practical takeaways that improve performance in quality and cost

The nonprofit health plan is putting these priorities into action through a range of collaborative initiatives:

• Building value-based care into provider contracts: Blue Shield is incorporating value-based care directly into its provider agreements, creating shared accountability for both quality and cost.
• Aligning across payers through primary care: Blue Shield continues to lead efforts to align incentives across payers through the multi-payer California Advanced Primary Care Initiative, working alongside other health plans to simplify expectations and make it easier for providers to meet clinical quality and member experience targets.   
• Strengthening provider partnerships: Blue Shield partners closely with physicians and health systems to support success in value-based models, with dedicated teams who work with providers to close care gaps, improve coordination, share actionable data, and reduce administrative complexity — all to drive better health outcomes and lower costs. 

Blue Shield’s work aligns closely with broader national efforts to expand value-based care, including initiatives led by the Centers for Medicare & Medicaid Services (CMS), like ACCESS, which aim to accelerate payment models that reward measurable improvements in patient health outcomes, rather than volume of services. Blue Shield has a long track record of supporting these efforts through programs such as Primary Care First and the California Advanced Primary Care Initiative, a multi-payer collaboration.