Blue Shield of California: University of California-Berkeley Study Finds Small-Network ACO Model Lowers Costs, Improves Patient Experience

Blue Shield of California’s accountable care organization (ACO) model was the subject of a study by the University of California at Berkeley. Researchers found that the model, which uses a smaller network of engaged providers and comprehensive care navigation, lowers costs and improves experience. 

The study compared data between a small-network health maintenance organization (HMO) plan and a large-network HMO plan offered by Blue Shield to San Francisco Health Service System members. While both showed positive results, the small-network plan lowered costs by more than $1,200 per year and led to greater patient engagement. In fact, researchers found that small-network plan members were:

  • More satisfied with their plan overall (7.1% higher satisfaction score)
  • More likely to visit their primary care physician as soon as needed (10.1 percentage points)
  • More likely to say that it’s easy to get a referral from their primary care physician (8.4 percentage points)
  • More likely to see a specialist as soon as needed (11.2 percentage points)
  • More satisfied with the mental health care they received (36% higher satisfaction score)

Researchers attributed the small-network plan’s strong results and lower costs to the ACO model’s robust patient navigation and customer support system.

Under the model, which Blue Shield launched in 2010, members can resolve a claim and get help with appointments, care transitions, medications, and questions about their doctor’s instructions. These services help reduce unnecessary utilization and increase member satisfaction. 

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