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Blue KC partners with Cedar Gate Technologies on value-based care

Blue Cross Blue Shield of Kansas City is partnering with Cedar Gate Technologies, provider of analytics and bundled payment systems, in an effort to boost Blue KC’s value-based care initiatives.

Blue KC provides coverage to more than one million residents in the greater Kansas City area, including Johnson and Wyandotte counties in Kansas and 30 counties in Northwest Missouri.

The Blue’s move to partner with Greenwich, Conn.-based Cedar Gate is part of the health plan’s goal to move away from fee for service approaches, according to Greg Sweat MD, senior vice president and chief medical officer of Blue KC, who says the payer is “purposefully pursuing” value-based care models that lower the cost of care and improve patient outcomes and satisfaction.

"Cedar Gate enhances our analytic capabilities and complements our risk management expertise, so we can deliver value-based care for our patients and provider organizations," Sweat adds.

The new partnership with Cedar Gate will help Blue KC optimize risk-based contracts, reduce medical spending, improve medical loss ratios, and improve provider network and clinical performance, according to Cedar Gate. The partnership will also support Blue KC's efforts to better engage patients with wellness programs, transparency tools, and information on how to keep healthy and manage chronic conditions.

David Snow, Jr., Cedar Gate’s founder and CEO, says the company’s cloud-based SaaS platform, called ISAAC—which will be in use at Blue KC—“is purpose-built to optimize the performance of any and all risk-based initiatives," including upside only, upside downside, risk corridors, prospective bundles, retrospective bundles and global capitation.

Cedar Gate has had success in helping its clients realize value from more than $96 billion of medical spending associated with risk-based contracts and programs that affect 3.4 million covered lives. The company has processed more that 2.25 million distinct bundles, it says.

Last November, Cedar Gate announced that its partnership with Franciscan Alliance, a faith-based, integrated healthcare provider, resulted in Franciscan Alliance improving the performance of its Franciscan ACO by $44.4 million between 2016 and 2018.

Participation in the federal value-based insurance design model is rapidly growing. According to the Centers for Medicare and Medicaid Services, the number of Medicare Advantage enrollees in value-based insurance design models more than tripled from last year to this year. In 2020 so far, CMS reports there are more than 1.2 million beneficiaries enrolled in MA plans offered by 14 participating MA organizations across 30 states and Puerto Rico—up from only seven states in 2019.

CMS has also indicated that ACOs should be prepared to start taking on two-sided risk, which some experts believe might cause some ACOs to leave the voluntary federal program. Those same experts, in a recent report published in Health Affairs, say more data on performance, along with analytics, could help ACOs succeed.

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