Question/ Intervention Goal/ Objectives
BizMed Blue-Ribbon Direct strives to address employers’ short- and long-term health cost and quality issues by strengthening primary care. Primary care practices that apply the Blue-Ribbon Direct tenets may reduce overall expenditures for medical care. The Blue-Ribbon tenets address access, continuity, safety and comprehensiveness of patient care.
For example, training and processes for referrals to specialists are part of the program; with this in place, primary care practices can make specialist referrals less frequent and more effective. https://www.bizmedsolutions.com/
The Blue-Ribbon primary care practices receive training, systems, and resources to improve the management of patient care. Specifically, the program goals are to increase use of preventive care, improve management of chronic diseases, reduce referrals to specialists, increase medication effectiveness (e.g. compliance), and reduce the need for urgent, emergency, and hospital care.
BizMed offers an illustrative business case, demonstrating how Blue-Ribbon practices may reduce medical expenses. The business case makes reasonable assumptions about what percentage of plan members would use Blue-Ribbon practices. It applies national sources to estimate annual increases in health care costs. It uses a credible source to estimate what portion of total health costs are spent on primary, specialist, and hospital care as well as prescription drugs.
Findings/ Metric/ Outcome/ Savings
The business case estimates an overall impact of Blue-Ribbon Direct at 5 to 15% of employer total healthcare costs based on four cost components shown in Table I. An employer group whose members use Blue-Ribbon physician practices would spend 20 to 30% less than it previously did on specialty physician services. Similarly, a group using Blue-Ribbon practices could reduce its prescription drug expenses by 10 to 20%. Use of and expense for primary care would increase.
The estimated savings from using Blue-Ribbon practices is based upon literature showing that primary care influences certain costs. For example, Cole et al. found that Patient Centered Medical Home patients had lower inpatient admissions than patients of non-PCMH practices. Literature overall on PCMH and other primary care focused initiatives have shown mixed results. The business case’s estimated impact is higher than studies of similar programs have found, but the Blue-Ribbon program requirements may differ or are more focused. Similar programs have not been shown to reduce the cost of specialist care by 20%, for example.
No formal definitions for the cost items were offered; these would be required in order to measure BizMed’s results from an actual case and compare those to the literature.