New payment models

Our new payment models are customized to improve outcomes for patients and meet the needs of all kinds of care, from large hospital systems to specialty practices and independent clinics.

When it comes to price, location matters

The cost of care in Minnesota can vary depending on where you live, but that’s not a fair system. For inpatient and outpatient care throughout Greater Minnesota, Blue Cross is:

1. Shifting to a data-driven pricing systems used in other parts of the country
2. Factoring the patient’s state of overall health when they seek care into pricing

Same inpatient procedure, two very different patients

A patient with complex heath issues requires more attention than someone who is considered healthy. For example, Ann and Barb both need a knee replacement, but each has different care needs:

Same inpatient procedure, two very different patients

No two patients are exactly alike. Under our new payment model, the hospital will be paid at a higher rate for Barb’s knee replacement than for Ann’s, reflecting the higher level of care that Barb required.

Simplifying outpatient billing

When you go to the doctor, we often pay a separate bill for all of the services you receive. In addition to the office visit, any additional work like lab tests, shots, or x-rays all come with their own separate bill.
This type of billing creates a lot of extra costly administrative work. Here’s how new bills will look:

Simplifying outpatient billing

Leading the way for better health care outcomes

This approach is already working in 10 care systems across Minnesota. In two years, this model has:

  • Reduced overall costs of care
  • Increased our understanding of quality outcomes
  • Optimized our ability to care for chronic conditions like diabetes and heart disease
  • Improved early detection and preventive care for treatable diseases like colorectal and breast cancer

Check out this map of care systems across Minnesota who have successfully tested our new system:

Map of care systems across Minnesota who have successfully tested our new system