What They’re Watching: Staici West, Premera Blue Cross

Staici West is the Director of Provider Network Management & Solutions at Premera Blue Cross. She joins us in this edition of “What They’re Watching” to discuss value-based contracts.

“So, our goal with value-based is really to develop contracts that are threefold. One – improve the patient experience or member experience, two – improve quality outcomes, and three – reduce the total cost of care. But there’s another factor that people don’t think about and that’s really scalability. So, if we have thirteen thousand contracts in Washington State, how do you develop contracts that can be applied to multiple specialties, providers, and hospitals that administratively we can operationalize all of them? So, what specialty do you focus on?

We’ve actually been working on value-based for about ten years. We have our global outcomes contracts that are multi-specialty clinics we’ve been contracted with, but how do we now take that to the next step and go to hospitals as well as single specialty clinics in a way that we don’t burden or add administrative costs to the system? So, just focusing on the development of the contract, but as well as what specialty to interact with first, and how do you stage it? It’s just refreshing to have a provider actually come to you rather than the traditional fee-for-service negotiation to say, “hey, we understand that healthcare isn’t sustainable and we understand that we have all these learnings and that you, Premera, want to get into the value-based space.”

What was really exciting about Arthritis Northwest is it was all about the patient and that’s the approach, the member, that we want to take; so the cultures just really aligned easily. Certainly, there were barriers that we had to work through but this was the first approach that the provider partner came to us and we were very easily able to collaborate to put together an agreement. And is this the last agreement? I don’t know, we’ll modify as we go but there’s a willingness to be vulnerable with each other and trust each other and that’s what the magic sauce is.”