Contracting directly with BSWQA means that employers, along with their third party administrator (TPA) of choice, work to create innovative and affordable benefit plan options that utilize the BSWQA care model for improving the quality of care through member engagement, care coordination, provider engagement and data analytics. The aim is to guide employers on a path to a healthier, happier and more productive workforce.
BSWQAs philosophy adheres to the belief that success in value-based care delivery is achieved when:
- Clinical processes are aligned as close to the provider and patient as possible
- Barriers to care caused by administrative hurdles and red-tape are reduced
- Care is managed across all sites of care
- Accountability for improving quality and efficiencies are monitored and reported
Employer Benefits and Cost Savings
Employers reap benefits that include cost management through BSWQAs integrated care model and health plan benefit design tailored to meet the company’s unique needs and a healthier workforce.
Employees receive cost-sharing or premium reductions if they take positive steps to improve their health, such as participating in their own condition management through a chronic care program. These incentives are now standard parts of most ACO benefit packages.
What does this mean for an organization’s employees? The key patient benefits include:
- Improved benefit design centered on offering a best-in-class care experience at reasonable costs
- Convenient access to quality primary and specialty care physicians, hospitals and post-acute care facilities, retail clinics, urgent care centers and select practices offering "after-hours" care
- Comprehensive Care Management where RN care managers, health coordinators, and licensed social workers proactively reach out to members and assist them in navigating the healthcare system and maintaining compliance with doctor-driven treatment plans
- Chronic Disease Management to help those with chronic illness manage their condition, maximize the impact of their doctor’s treatment plan, improve quality of life and reduce the need for costly healthcare
- Preventive Health Services focused on wellness, early detection and prevention of chronic disease
- Aligned incentives so that doctors are rewarded for improving healthcare quality and efficiencies resulting in health plan savings
- Proven results for improved healthcare quality, innovative care management and reduced medical plan costs
Direct Contracting with BSWQA
BSWQA focuses on cost by managing the population to successfully increase member engagement, appropriate utilization and risk reduction. BSWQAs Providers are approximately 16 percent below its competitors in the market for total cost of care. BSWQA provides innovative pricing models to employers so that we can collaborate and become part of the solution to reducing cost together.
- Shared Savings Risk Model – BSWQA shares in the risk year two and forward. (Based on Member Thresholds)
- Unit Price Discount to give employers savings when members stay in the BSWQA facility network
- Third Party Trend Guarantee – Market-based trend determines target and provides employer insight into cost differentials
- Market Trend Discount – BSWQA will take the market trend and discount it when projecting performance for the next performance year. This requires even more focus on controlling cost and utilization for BSWQA.
BSWQA Proven Results
Putting BSWQAs integrated care model to work has resulted in significant improvements in health outcomes and medical costs savings.
Health Outcome Improvements*
- 22 percent fewer hospital admissions
- 10 percent drop in 30-day re-admissions
- 27 percent improvement keeping member in-network
- Zero trend in total medical costs
- $57 million in medical cost savings
*Based on reported results and expected trends from Baylor Scott & White Employee Health Plan North Texas Division