Blue Shield of California Is Betting Medicare’s Payment Model Can Work in Commercial Plans

Blue Shield of California is betting that how the government pays for healthcare can change how insurers pay for it. The company is one of 17 major health plans that have signed on to adopt payment models based on the Medicare Innovation Center’s ACCESS Model.

Ravi Kavasery, the insurer’s chief medical officer, told STAT that the plan is still working through the details. That includes deciding whether to copy Medicare’s payment amounts and which organizations it will partner with. Blue Shield of California serves 6 million members, and Kavasery expects the insurer to launch similar models in commercial plans in 2027.

What the ACCESS Model Is

The Medicare Innovation Center’s ACCESS Model is part of the agency’s push toward value-based care. It is designed to reward providers for keeping patients healthy rather than just treating them when they get sick.

Kavasery did not say exactly which parts of the model Blue Shield of California plans to copy. He described the process as still underway, with open questions about payment amounts and partnerships.

The 17 Plans

Seventeen major health plans have now committed to adopting payment models inspired by the ACCESS Model. Blue Shield of California is one of them.

The commitment from multiple insurers is notable. The source does not describe how the other plans are moving forward.

What Blue Shield Is Still Working Out

The path from commitment to launch is not smooth. Kavasery identified three main unknowns:

• Whether Blue Shield of California will adopt CMS payment amounts
• Which organizations it will work with
• Exactly how the model will look when it launches

Those questions will shape whether the final product resembles the original Medicare model or takes a different form. The 2027 timeline gives the company room to work through them.

Why This Matters

Blue Shield of California’s move is notable because it is a large commercial insurer. Its experience with 6 million members means any lessons learned could travel quickly to other plans.

The 2027 launch date is significant. By then, other insurers will have had time to watch the ACCESS Model in action.

The Bottom Line

Kavasery’s openness about the remaining questions is a good sign. The proof will come when the models actually launch.

Blue Shield of California is betting that tying payments to results works better than paying for visits. The next few years will show how the model holds up.

Source material: “STAT+: A major insurer on how it may replicate Medicare’s chronic-care experiment,” STAT.

ACCESS Model · Blue Shield · health insurance · Medicare · payment models