Premera

The Challenge

Premera Blue Cross is a leading health care provider to more than 1.7 million people across Washington State and Alaska, with over $3 billion in revenue. Recognizing the unsustainability of increasing health care costs, Premera Blue Cross saw a business imperative to develop innovative programs that would challenge both the way health care is delivered, and how providers are reimbursed, while simultaneously improving outcomes and helping control costs.

Our Approach

Given the unprecedented nature of this project, the ultimate work product was something of an unknown. Thus, a critical aspect for project success was keeping stakeholders on the same page. Following a collaborative working session with Premera, as well as partner hospitals and clinics, Slalom helped identify a unique set of requirements and deliverables to facilitate program roll out, as well as strategize how to present the program in a way that would facilitate regulatory approval. By challenging each other to look inside the current paradigms for ways to incentivize providers to improve care delivery to patients, team members were able to build a common understanding among participants and create a program – the first of its kind in the region –whereby providers accepted payment based on health outcomes.

The Results

Slalom's project management expertise was instrumental in Premera's implementation of this innovative health care delivery program. Premera members can now enroll in the program based out of a Seattle-area clinic. The business model has allowed physicians to reduce barriers to care, giving them more flexibility and patients better guidance on accessing the most appropriate mode of care, while at the same time controlling costs. In addition, a contractual agreement is in place with the clinic to base reimbursement on health-related performance metrics, which also encourages more emphasis on quality preventive care.