Blue Cross, Prospect Health Services announce value-based care agreement

PROVIDENCE – Blue Cross & Blue Shield of Rhode Island and Prospect Health Services of Rhode Island Inc. have announced a value-based care agreement, which directs reimbursement toward better care for patients rather than for the volume of health care services provided.

The deal encompasses Prospect’s care of nearly 10,000 Blue Cross Medicare Advantage members.

“At Blue Cross, we are passionate about shifting from the sick care system we have today to one focused on keeping people healthy,” said Blue Cross CEO and President Martha L. Wofford. “Everyone wins when providers are rewarded for high-quality, proactive care – health care costs go down and, most importantly, patients stay healthier. We’re pleased to be entering into this agreement with Prospect.”

Prospect Health Services of Rhode Island Inc. is part of Prospect Medical Holdings Inc., which operates CharterCARE Health Partners in Rhode Island, including Roger Williams Medical Center, Our Lady of Fatima Hospital, Roger Williams Cancer Center, Southern New England Rehabilitation Center, Blackstone Valley Surgicare, and CharterCARE Medical Associates.

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The deal will create financial incentives for improving the quality of health care and keeping patients well through better preventative care, according to Blue Cross.

Improvements involve coordination between patients’ various providers, who are then able to spend more time with patients who have complicated medical needs, the insurer noted.

Steve O’Dell, president of coordinated regional care at Prospect Medical Holdings, called the agreement “fully representative” of health care’s future direction.

“We are pleased that BCBSRI has taken this bold step forward in supporting value over volume and we encourage other health insurers in Rhode Island to join us as well,” O’Dell said. “We have made considerable progress in the past several years because our value-based care team collaborates closely with our patients and primary care physicians.”

Elizabeth Graham is a PBN contributing writer.