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Rewarding Quality Care Reaps Rewards For All

By January 5, 2017August 16th, 2021Health Insurance
Physicians high-five a patient laying in a hospital bed

Recently I had the pleasure of meeting with fellow Blue plan sales leaders from around the country to discuss the strengths the Blue system offers our customers. While we agreed on many, one stood out — our commitment to driving patient-focused care and improving the health care experience.

By continuing to partner closely with doctors, hospitals, and health care systems we can deliver effective, efficient, and coordinated care. Together these steps will lead to improved outcomes. Value-based programs tied to the Blues’ well-established provider relationships coast to coast allow us to offer the best possible scenario – members have access to optimal care while employers get the best value for their dollar – a true win/win. Through sharing stories around the room at this meeting, we realized these programs are essential to providing our members the right care, in the right place, at the right price.

The American health care system’s past focus on service “quantity” has been flawed; the traditional approach was that if doctors do more, they should earn more. Providing health care is not like manufacturing widgets; patient health can’t be compared to things you build or sell. There’s no such thing as getting by or cutting corners when it comes to an individual’s health. Quality must come before quantity every time.

Pay for performance programs in primary care encourage and reward doctors and hospitals for putting the patient at the center of the health care experience. Instead of health care providers receiving payment based on how many patients they see, they receive incentives based on how they treat them. As a result, wellness is emphasized over sick care, and patients are educated about their conditions and highly involved in treatment decisions. Plus, practices are staffed by professionals who can assist in all stages and areas of health care, making the primary care office a one-stop destination.

Independence has long been at the forefront in delivering value-based initiatives that improve the quality of patient care and lower health care costs for everyone. Programs like the ACO (Accountable Care Organization) payment model, we introduced in 2011, have demonstrated success in incentivizing enhanced care coordination, and lowering costs, across the delivery system. Working alongside our fellow Blues, the Blue Cross and Blue Shield plans provide a portfolio of more than 570 quality care programs that tie more than $71 million in medical claims to programs that focus on prevention, wellness, access to care, disease management and care coordination.

The foundation we have collectively laid with these and other programs set the backdrop for the next phase of this continued journey as we focus on accelerating the adoption of progress new payment programs and helping doctors and hospitals adapt to new models of care.

In an industry overwhelmed by rising costs, these programs aren’t just a nice idea … it’s a realistic change that holds amazing promise to rein in costs while improving quality.

I am personally encouraged and invigorated by all that Blue plans are doing to positively impact the quality of care our members receive and also help employers to keep costs down. This is an evolving process, and one that Independence has and will continue to lead. Stay tuned, gang!

This article was originally published on LinkedIn Pulse


Peter S. Panageas

Peter Panageas is senior vice president and market president — national for Independence Blue Cross. In this role, Mr. Panageas has profit-and-loss responsibilities focused on new business and retention for all groups 1,000+, including Large Local, National, Health & Welfare, Education, and FEP. Mr. Panageas joined independence as vice president of Sales in 2010. During his tenure with the company, he has implemented significant changes to the sales incentive program and improved the membership reporting capabilities to increase sales force effectiveness. Mr. Panageas is a respected client relationship leader with recognized expertise in new business creation, client relationship management, and innovative client solutions. Mr. Panageas received a bachelor of science degree from Rutgers University.