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St. Luke's, Blue Cross partner to use new value-based care platform

Stellar Health incentivizes St. Luke's to keep track of patient screenings and medical histories, which can save the patient and Blue Cross Blue Shield of Minnesota money spent on emergency care.

St. Luke's aerial photo
St. Luke's hospital in Duluth, pictured in July 2020. (Tyler Schank / File / News Tribune)
Tyler Schank / File / Duluth News Tribune
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Blue Cross Blue Shield of Minnesota is helping St. Luke’s tackle a proactive approach to quality patient care.

St. Luke’s partnered with the insurance company late last year to use the software platform Stellar Health, which helps providers like Duluth-based St. Luke’s focus on value-based care — a reimbursement model that focuses on patient outcomes — instead of service-based care.

Karen Amezcua, senior director of provider partnerships at Blue Cross, said the value-based care approach allows health care systems earn money without depending on expensive patient visits for service, like emergency care or procedures.

“If we can convert to value-based services, providers can manage a population,” Amezuca said. “Whether or not they need services, they are going to get reimbursed.”

While the value-based care approach isn’t new, Stellar Health makes it easier for St. Luke’s to get money by doing things it would already do anyway. Mike Laughlin, director of managed care finance at St. Luke’s, said Stellar Health will incentivize each point of contact made with a Blue Cross patient, including calling to schedule a screening or annual checkup; talking to a patient and making an appointment; reminding the patient about that appointment; seeing the patient and performing the screening; then submitting a claim to the patient’s insurance provider.

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“They have to do that kind of work anyway, but it tracks that they’re doing it and rewards them for doing it,” Laughlin said.

Michael Laughlin.jpg
Michael Laughlin (Photo courtesy of St. Luke's)

The benefits of this approach don’t just help St. Luke’s bring in revenue. With a proactive approach to screening patients regularly, patients are less likely to need emergency care, which is much more expensive.

While patients may not see much change in their medical bills, doing regular screenings can help find and treat serious conditions early, which can save both the patient and the insurance company money from emergency room visits, ambulance transport and other expensive services. Patients also may see changes in the amount of reminders they receive to make sure they are attending checkups on time.

“Sadly, many people use the emergency room as their doctor care and they don’t schedule appointments with a primary care or family doctor — they don’t really have one,” Laughlin said.

During the COVID-19 pandemic especially, providers relied heavily on revenue from performing services because so many people opted out of routine screenings. Many insurance companies have incentives for the care-based approach to care because the provider would not be earning as much revenue if they performed fewer services.

“We would lose money because we’re not seeing as many patients. We’re taking better care of them, but we’re not really being rewarded for that,” Laughlin said.

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The insurance incentives keep providers like St. Luke’s from having to raise prices as frequently.

“I think everyone realizes that health care is not sustainable,” Amezuca said. “So much of our economy is spent on health care, and with the trajectory that health care costs are on, we’re not going to be able to pay for it. I think we all together realize that we need to do something differently so people can afford health care.”

Stellar Health makes it easier for care coordinators to keep track of when patients are due for screenings, and helps remind them about the patient’s history, which can be important for medical coding for billing and insurance claims, Laughlin said. He said Stellar Health has gotten good feedback from St. Luke’s staff so far.

If providers don’t reach the targets set, Amezuca said there can be repercussions like lower reimbursements if they aren’t successful in driving quality in a particular health care trend.

Other health insurance companies can also use Stellar Health, which Laughlin said would help streamline care coordination by having all patients’ information on one platform. Right now, only Blue Cross-insured patients are in the system, and the rest of the patients are in the existing Meditech software.

Smaller independent providers like St. Luke’s don’t always have the resources to use services like Stellar Health, Amezuca said, so Blue Cross has funded the vendor fees for the first two years at St. Luke’s.

“We really want to support and keep independent providers viable,” Amezuca said. “There’s been a lot of acquisitions of independent providers over the years. We’re losing competition, and competition is healthy.”

This story was updated at 11:35 a.m. June 30 to clarify that the repercussions health care providers could face include lower reimbursements. It originally posted at 5:23 p.m. June 29.

Related Topics: HEALTH NEWSNEWSMDDULUTH
Laura Butterbrodt covers health for the Duluth News Tribune. She has a bachelor of arts in journalism from South Dakota State University and has been working as a reporter in Minnesota and South Dakota since 2014.
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