Independence Blue Cross Patient-Centered Medical Home Program
Program Location:
Harrisburg, PA
Number of Practices:
300
Payer Type:
Commercial
Parent Program:
Reported Outcomes
Description:
Independence Blue Cross (IBC) is an independent licensee of the Blue Cross and Blue Shield Association of Philadelphia and southeastern Pennsylvania. IBC revised its progressive incentive program, the Quality Incentive Payment System or QIPS, in early 2010 to attract and retain high-performing primary care physicians in southeastern Pennsylvania, as well as to motivate and encourage doctors to improve quality and provide care in a more efficient way, which helps control rising health care costs. Doctors received their first payments under the new incentive program in 2011, the largest incentive IBC has ever paid primary care doctors.
Several IBC medical home practices also participated in the Pennsylvania Chronic Care Initiative (CCI); fifteen of the seventeen practices included a study by the American Journal of Managed Care took part in CCI.
Payment Model:
Enhanced payment for NCQA recognition; ACP Medical Home Builder 2.0 (MHB) In addition to earning additional pay for running their practices as medical homes, doctors can earn QIPS incentives based on achievements in the following three additional areas: Coordinating cost-effective care; Prescribing generic drugs; Delivering quality care
Fewer ED / Hospital Visits:
Health Services Research (August 2014):
- 5-8% reduction in ED utilization for patients with chronic illness (data review 2008-2012)
- 9.5-12% reduction in ED utilization for patients with Diabetes (data review 2008-2012)
American Journal of Managed Care Evaluation (March 2014):
- 10.8 percent fewer readmissions than control group (2009)
- 8.6 percent fewer readmissions than control group (2010)
- 16.6 percent fewer readmissions than control group (2011)
Improved Health:
BlueCross BlueShield Industry Report (2008-2011)
Better diabetes care:
- Increased diabetes screenings from 40% to 92%
- 49% improvement in HbA1c levels
- 25% improvement in BP control
- 27% increase in cholesterol control
- 56% increase in patients with self-management goals
Cost Savings:
American Journal of Managed Care Evaluation (March 2014):
- total medical cost savings of 11.2 percent (2009) in PCMH high-risk group
- total medical cost savings of 7.9 percent (2010) in PCMH high-risk group
IBC Press Release (July 2013):
- diabetic members treated in a medical home practice had 21 percent lower total medical costs, driven by a 44-percent reduction in hospital costs
- Lower emergency room costs were seen after one year
- IBC also found reductions in costs for members with chronic conditions such as coronary artery disease, congestive heart failure, chronic obstructive pulmonary disease, asthma, and hypertension
Data Source(s):
Blue Cross Blue Shield Industry
Last updated February 2015
