We are committed to developing value-based programs that foster high-quality, efficient health care for our members. Through these programs, we work collaboratively with physicians and hospitals to improve the quality of our members’ experiences and overall outcomes. More information about our value-based programs is included below

Accountable Provider Organizations

Accountable Provider Organizations (APOs) align compensation to quality of care, patient satisfaction, affordability, health equity, and health outcomes. APOs are responsible for achieving clinical quality and cost-efficient care by avoiding unnecessary and duplicative medical tests and treatments for a defined patient population. Like Medicare’s Accountable Care Organizations, Florida Blue’s commercial APOs focus on primary care providers (PCPs), specialists, and hospitals who care for members with commercial plans. 

APOs rely on primary care as their foundation because of the strong focus on preventive and wellness care to keep patients healthy. They manage patients through an attributed PCP, but also include specialists and other types of providers. They may focus on specific diseases or be multi-specialty groups. They may also have third party accreditation. Patients are encouraged to maintain an ongoing relationship with a PCP for continuous comprehensive care.

Value-Based care and APOs deliver coordinated and/or integrated care based on a whole person approach. Here are some additional points about Value-Based care and APOs:

• The attributed PCP is responsible for addressing all the patient’s health care needs and arranging appropriate care with other qualified professionals when applicable. This includes care for all stages of life: preventive services, acute care, chronic care, , and end-of-life care.
• All elements of the complex health care system (e.g., subspecialty care, hospitals, home health agencies, and nursing homes) and the patient’s community (e.g., family, public, and private community-based services) are coordinated. Care is facilitated by registries, information technology, health information exchange, and other means to ensure patients receive culturally suitable care, when and where they need it. 
• Designated Value-Based Performance Consultants are able to identify opportunities for improvement and ensure understanding of performance scorecards. They also help assess practice infrastructure and alignment for activities critical to program success.

Episode Bundle Program

Episode Bundle Program focuses primarily on specialists with the goal of improving the cost and quality of episodic care. These physicians agree to be accountable for the entire cost and quality of certain acute or chronic episodes of care. 

Bundled services are measured against a target episode cost. Cost savings for the entire episode cycle, including post-acute complication avoidance is reflected in decreased medical spend. The savings are shared with the physician practice.

Some of the primary procedures in the bundled package include:

• All related surgical procedures, including anesthesia services, injections, or drugs administered during the surgical procedure
• Radiology/imaging services
• Cost of the implant and surgical supplies
• Discharge planning and nursing care
• Pre- and post-office visits

We work with several physician practices to focus on entire episodes of care; identify improved quality paths/patterns for treatments and cost efficiencies achieved through improved or equal quality.