Blue Cross and Blue Shield of Texas now the largest value-based contract for Baylor Scott & White Health’s ACO

Blue Cross and Blue Shield of Texas (BCBSTX) has reached an agreement with Baylor Scott & White Quality Alliance (BSWQA)Baylor Scott & White’s accountable care organization (ACO) to deliver high-quality and lower cost care to more than 140,000 BCBSTX members in North and Central Texas.

“This agreement is a major step forward as we shift from a fee-for-service to a fee-for-value healthcare model,” said Dan McCoy, MD, president of Blue Cross and Blue Shield of Texas. “We now have more than 1 million lives under value-based-care arrangements. It goes without saying that aligning with a health system with Baylor Scott & White Health’s reputation means our members and their patients will receive high-value, coordinated and quality care.”

The BCBSTX agreement represents BSWQA’s largest value-based arrangement with a commercial insurance company. BSWQA, one of the largest ACOs in Texas, now has more than 600,000 covered lives. Value-based care focuses on improving quality of care and the member experience while reducing medical costs for a specific group of patients.

BSWQA is composed of over 6,000 primary and specialty care physician members, 50 hospitals, more than 95 post-acute care facilities and other healthcare stakeholders that agree to be accountable jointly for improving quality, enhancing the patient experience and reducing healthcare costs. BSWQA has earned National Committee for Quality Assurance (NCQA) ACO accreditation. NCQA’s ACO accreditation rates the level of preparation by ACOs to improve healthcare quality and efficiency while reducing costs.

“This opportunity aligns with our strategy to provide quality, value-based care, an improved customer experience and increased affordability for those we serve,” said James H. Hinton, CEO, Baylor Scott & White. “Members enrolled in this new ACO arrangement have access to BSWQA’s comprehensive network of primary and specialty care doctors and facilities with a proven track record for accountability and delivering quality care that is efficient and affordable.”

An ACO is a healthcare collaboration that, among other things, ties payments to quality measures and the cost of care. ACOs are formed by a group of providers, hospitals, payers and other health care stakeholders committed to being accountable to patients and payers for the quality, appropriateness and efficiency of healthcare services. ACOs strive to ensure that patients get the right care at the right time and at the right cost.

The relationship between BCBSTX and Baylor dates to 1929, when the then-superintendent of Dallas schools, Justin Ford Kimball, became a Baylor University official. Wanting to improve the quality of healthcare for educators, Kimball devised a plan that allowed teachers to contribute to a fund that would guarantee up to 21 days of hospital care at Baylor Hospital. The program became the first Blue Cross and Blue Shield plan in the U.S.

Over years, the relationship between BCBSTX and Baylor Scott & White has grown, with the BCBSTX/BSWQA ACO arrangement – effective this month – further linking the two healthcare organizations and serving as an evolution in their professional collaboration.