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Quality and Affordability

A critical part of our mission is ensuring that high-quality health care is affordable for all Californians. We must both improve the quality of care and control the rising costs. The following are some of our key efforts to address the affordability crisis.

Blue Shield’s pledge

To do our part to keep coverage affordable, Blue Shield of California made this pledge: we will limit our net income to 2%.

Value-based care

Blue Shield believes that an essential part of improving the healthcare system and addressing the affordability crisis is the development of programs that reward high-quality and high-value care. Blue Shield has committed to having 40% of our healthcare spending in value-based payment models by 2016, and 60% by 2018.

We participate in a Learning and Action Network launched by President Obama and Secretary Sylvia Burwell of the U.S. Department of Health and Human Services.

Accountable care organizations

We collaborate with doctors and hospitals through our accountable care organizations (ACOs) to improve healthcare delivery and quality of service, and to reduce cost.


Innovative programs that expand access and lower costs

We also have implemented a number of innovative programs to keep costs down and improve quality, including:

  • Partnership in Operational Excellence and Transparency (POET) aims to reduce administrative costs and improve transparency in claims processing between Blue Shield and our network hospitals

  • Pay-for-performance programs that encourage better quality health care by rewarding high-performing providers

  • Telehealth program provides remote specialty care access

  • Blue Shield of California Foundation makes grants to support the healthcare safety net and domestic violence prevention, helping health care to become more effective, safe and accessible for all Californians