A new approach to paying doctors

The current health care system provides important services to Blue Cross members every day. However, the trend of rising health care costs continues to put pressure on the affordability of insurance.

The connection between the cost of care and your premiums

Blue Cross wants to make sure every member receives high quality health care at a great value. We also believe payments for care should be fair and consistent among all doctors, hospitals and clinics in our network. That’s why we’re taking the lead to change the current system of health care payments.

There's a connection between the cost of care and your premiums

Let’s reward better care

Most hospitals and clinics use the “fee-for-service” model today. This simple structure starts with a set price list for services provided. Blue Cross then pays a fee every time a covered service is provided to one of our members.

There’s one problem with this model: it doesn’t reward good outcomes. Fee-for-service has also done nothing to keep cost of care from increasing year-over-year. It also allows for significant differences in hospital billing for common procedures. Depending on where a Blue Cross member goes for routine care, the price difference for the same service can range anywhere from 500% to 1,000%.

Same care, random swings in cost

The following are real examples of low and high prices that Blue Cross pays for common procedures throughout the state:

Examples of prices Blue Cross members paid across the state for the same procedures

Making changes to impact outcomes

Blue Cross is doing four key things to impact outcomes and increase affordability:

  • Moving away from the limitations of fee-for-service
  • Creating new, economic incentives for doctors to deliver even higher quality care
  • Addressing the skyrocketing costs of the overall health care “spend” in our society
  • Helping members and consumers find information about the cost of their care

Want to learn more about how we’re managing costs? Learn about new payment models