Blue Cross and Blue Shield of Minnesota, Herself Health Shift
Blue Cross and Blue Shield of Minnesota and Herself Health, a primary care company for women over 65, have shifted their payment structure from a fee-for-service arrangement to a value-based arrangement, the companies recently announced.
St. Paul, Minnesota-based Herself Health offers older women support for social isolation, mental health, bone health, heart health and brain health. Its services are available virtually and in person at its clinics in Minneapolis and St. Paul, Minnesota.
The new arrangement between Herself Health and Blue Cross and Blue Shield of Minnesota will focus on patient outcomes rather than the volume of services provided. It will center around quality metrics like preventive care and effective management of chronic conditions. The agreement focuses on Blue Cross’ Medicare Advantage members and applies retroactively to January 1, 2024. The companies first began working with each other in January 2023.
“Our enhanced contract with Blue Cross and Blue Shield of Minnesota prioritizes patient outcomes, emphasizing the inclusion of specialized services beyond standard primary care which are essential for improving health outcomes,” said Kristen Helton, CEO and co-founder of Herself Health, in an email. “These services combined with our focus on preventative care and effective condition management, are key to reducing unnecessary medical costs and enhancing overall healthcare quality.”
The value-based payment structure is also a “win” for members by incentivizing fewer hospitalizations, improved health outcomes and lower cost of care, a spokesperson for Blue Cross and Blue Shield of Minnesota said in an email.
“The new value-based agreement means we are increasing payment incentives for quality while lowering the emphasis on quantity or transactional care,” the spokesperson said. “We expect to see better health outcomes in terms of preventive care and management of chronic conditions that more commonly affect older women, such as osteoporosis, autoimmune diseases and Alzheimer’s. Financially, we expect to see a lower total cost of care that can help our members stretch their healthcare dollar while allowing Blue Cross to reinvest in future innovations.”
The news comes at a time when about one in five women have no healthcare provider and 10% of women say they can’t see a provider due to costs, according to the National Council on Aging. Older women are often underserved and overlooked by the healthcare industry, according to Helton. Shifting to a value-based payment model will greatly support this population.
“This approach allows us to provide more personalized, preventive care that addresses both chronic conditions and broader wellness needs. It also supports building long-term relationships with our patients, ensuring holistic care that enhances health outcomes and quality of life,” Helton said. “Aligning financial incentives with patient success further promotes a sustainable healthcare system that balances quality and affordability to keep our communities healthy.”
Other companies that provide primary care support for women include Hello Alpha and Tia, though these companies don’t exclusively support older women like Herself Health does.
Photo: kate_sept2004, Getty Images
