Blue Cross & Blue Shield of Rhode Island and Prospect Announce New Agreement

 Blue Cross & Blue Shield of Rhode Island and Prospect Announce New Agreement
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Value-based care model is designed to transform patient experience

PROVIDENCE, RI (April 22, 2022)— Blue Cross & Blue Shield of Rhode Island (BCBSRI) and Prospect Health Services of Rhode Island have announced a Medicare Advantage global capitation agreement. Prospect will be reimbursed for delivering effective care to its nearly 10,000 BCBSRI Medicare Advantage patients, rather than for volume of services provided. This approach, defined as value-based care, creates financial incentives for improving the overall quality of care, increasing preventive care, and keeping people well.

Key to value-based care is the rigorous coordination of care among a patient’s providers, including primary care physicians, specialists, and behavioral health providers and pharmacists embedded in the Prospect accountable care organization (ACO). This includes a care team providing patients with appropriate education, tools and services for in-home care, and telehealth visits to help prevent unnecessary and costly visits to the emergency department, as well as unnecessary hospital readmissions. As patients are better informed and more proactive, they are encouraged and empowered to collaborate directly with their providers and assume more responsibility for keeping themselves well.

For providers, the value-based care approach allows for spending more time with patients who need the greatest support, while encouraging coaching and enhanced supervision of the growing number of patients who are more actively managing their own health. As providers manage better patient outcomes, their total compensation increases.

“At Blue Cross, we are passionate about shifting from the sick care system we have today, to one focused on keeping people healthy,” said BCBSRI President and CEO Martha Wofford. “Everyone wins when providers are rewarded for high quality, proactive care – health care costs go down and most importantly patients stay healthier. We’re pleased to be entering into this agreement with Prospect.”

Steve O’Dell, Prospect Medical Holdings’ president, coordinated regional care, agreed, saying, “As a major provider group in Rhode Island, we consider this agreement fully representative of the future direction of healthcare. We are pleased that BCBSRI has taken this bold step forward in supporting value over volume and we encourage other health insurers in Rhode Island to join us as well. We have made considerable progress in the past several years because our value-based care team collaborates closely with our patients and primary care physicians. This approach reflects our ongoing commitment to supporting and empowering our providers and patients to work together toward better health outcomes.”

About Prospect Medical Holdings


Prospect Medical Holdings, Inc., established in 1996, is a national leader in fully integrated healthcare. We are proud to provision healthcare services for more than 715,000 enrolled members through integrated networks of primary and specialty physicians, in affiliation with hospitals, clinics, other community-based providers and health plans. Prospect owns and operates 17 hospitals and more than 165 clinics and outpatient centers, with primary operations in California, Connecticut, Pennsylvania, Rhode Island, and Texas.

In Rhode Island, Prospect operates CharterCARE Health Partners, a system of care that includes Roger Williams Medical Center, Our Lady of Fatima Hospital, Roger Williams Cancer Center, Southern New England Rehabilitation Center, Blackstone Valley Surgicare, and CharterCARE Medical Associates, a multi-location group practice that offers primary care and access to specialized physician care. In addition. CharterCARE Provider Group of Rhode Island is an independent physician association with more than 500 primary care doctors and specialty physicians delivering value-based care to more than 72,000 Rhode Island residents.

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