Total Care represents a significant advancement in the healthcare landscape, establishing itself as the nation’s leading network of value-based programs. These programs, encompassing Accountable Care Organizations (ACOs) and Patient-Centered Medical Homes (PCMHs), prioritize the quality of patient care over the volume of services provided. By focusing on enhanced care coordination, proactive chronic condition management, and a strong emphasis on preventative measures and overall wellness, Total Care is dedicated to empowering individuals to maintain their health and minimize hospitalizations.
Elevating Quality and Achieving Superior Outcomes through Total Care
The core mission of Total Care is to drive tangible improvements in healthcare through more effective care coordination. A commitment to preventative care and comprehensive wellness programs underscores this mission, ensuring patients receive the support needed to make informed decisions about their health. Total Care providers are specifically focused on several key areas to achieve these goals:
- Improving Access to Primary Care: Total Care initiatives actively expand avenues for patients to receive primary care services, including the development of alternative care sites to broaden accessibility and convenience.
- Reducing Unnecessary Medical Interventions: A critical aspect of Total Care is the reduction of medical treatments and services that are deemed unnecessary, ensuring patients receive appropriate and efficient care.
- Effective Chronic Disease Management: Total Care places a strong emphasis on managing prevalent chronic conditions such as diabetes, asthma, and cardiovascular disease, employing proactive strategies to improve patient outcomes and quality of life.
- Prioritizing Preventative Care and Wellness: Regular screenings and immunizations are central to the Total Care approach, reflecting a commitment to early detection and preventative measures to maintain patient health and well-being.
Data consistently demonstrates that healthcare providers participating in Total Care programs excel in closing gaps in quality measures and effectively managing the evolving healthcare needs of their patients over time, leading to better overall health outcomes.
Eligibility and Evaluation for Total Care Designation
Total Care designation is a recognition of commitment to value-based care, and primary care physicians, medical practices, and hospitals are all eligible for consideration. Blue Cross Blue Shield (BCBS) companies across the nation employ a standardized set of criteria to rigorously evaluate candidates for Total Care recognition. These criteria include:
- Adherence to Quality and Cost Targets: Doctors and hospitals seeking Total Care designation must demonstrate a commitment to meeting pre-defined quality and cost targets. Their compensation from BCBS companies is, at least in part, linked to their success in achieving these targets, incentivizing the delivery of higher quality, more affordable patient care.
- Data-Driven Practice Improvement: A fundamental requirement for Total Care participants is the utilization of data and analytics to gain deeper insights into their medical practices and to drive continuous improvement in care delivery and patient outcomes.
- Broad Program Accessibility for BCBS Members: To ensure widespread impact, the programs offered by Total Care designated doctors and hospitals must be broadly available and accessible to Blue Cross Blue Shield members, maximizing the reach and benefits of value-based care initiatives.
