Pennsylvania

In response to Pennsylvania’s growing chronic disease burden and its impact on healthcare spending, the Governor issued Executive Order 2007-05 on May 21, 2007. This order created the Pennsylvania Chronic Care Management, Reimbursement and Cost Reduction Commission, also known as the Chronic Care Commission. The Commission proposed and then implemented the Pennsylvania Chronic Care Initiative (CCI) designed to achieve four strategic goals:

  • Widespread use of a new primary care reimbursement model that rewards PCMH care based on the Chronic Care Model.
  • Broad dissemination of the Chronic Care Model to primary care practices across Pennsylvania, through regional chronic care learning collaboratives. 
  • Achievement of tangible and measurable improvement in patiient satisfaction, access to care, health outcomes and quality of life.
  • Reduction in the cost of providing chronic care with the reduction of avoidable hospitalizations and emergency room visits and mechanisms to ensure that some of the savings are realized by all entities paying for health care. 

The first rollout (Southeast PA) started in May 2008 and six more learning collaboratives were launched through December 2009, involving a total of 152 mostly small and medium-size primary care practices and 640 providers (75% of the practices have 5 or fewer FTE providers). In four of PA’s seven regions, 17 payers, including Medicaid, provided $30 million in infrastructure payments to practices to support transformation. Since 2009, the state’s contracts with Medicaid managed care organizations (MCOs) have required MCOs to participate in the CCI. Phase II of the CCI began in January 2012 with funding from the Multi-payer Advanced Primary Care Practice demonstration.

CHIPRA: 
Yes
MAPCP: 
No
Dual Eligible: 
No
2703 Health Home: 
No
CPCi: 
No
SIM Awards: 
Yes
PCMH in QHP: 
No
Legislative PCMH Initiative: 
Yes
Private Payer Program: 
Yes
State Facts: 
Population:
12,759,200
Uninsured Population:
10%
Total Medicaid Spending FY 2013: 
$21.0 Billion 
Overweight/Obese Adults:
64.5%
Poor Mental Health among Adults: 
35.5%
Medicaid Expansion: 
Yes

Independence Blue Cross ACO

Independence Blue Cross is a nationally recognized health insurer serving nearly 8.8 million people in 24 states and the District of Columbia, including 2.5 million in southeastern Pennsylvania. Independence’s Accountable Care Organization (ACO) payment model has been embraced by more than 90 percent of the health care delivery systems in the region.

Will Health Reform Bring New Role, Respect To Primary Care Physicians?

on Thu, 2014-07-10 00:00   lisabeth

A few years ago it struck the D.C. region’s biggest medical insurer that the doctors who saw its members most often and knew them best got the smallest piece of the healthcare dollar. CareFirst BlueCross BlueShield spent billions on hospital procedures, drugs and specialty physicians to treat sick patients. Only one dollar in 20 went to the family-care doctors and other primary caregivers trained to keep people healthy.

The company’s move to shift that balance tells a lesser-known story of the Affordable Care Act and efforts to change the health system.

Story Date: 
July 10, 2014
News Author: 
Jay Hancock
Source Link: 
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South Central Pennsylvania Alliance (SCPA)

WellSpan Health is a collaborator and leader in Aligning Forces for Quality (AF4Q). Through this effort, area community leaders, consumers, physicians, nurses, employers and insurers have come together to help improve health care quality in the York/Adams county communities through several care coordination initiatives. 

South Central Pennsylvania Patient-Centered Medical Home Collaborative

Patient-Centered Medical Home Evaluations: Let’s Keep Them All In Context

on Wed, 2014-05-21 00:00   lisabeth

Since the American Academy of Pediatrics (AAP), American Academy of Family Physicians (AAFP), American College of Physicians (ACP) and American Osteopathic Association (AOA) issued their Joint Principles of the Patient-Centered Medical Home in 2007, there has been an explosion in medical home transformation activity in the United States.  According to the National Committee for Quality Assurance(NCQA), which offers one of multiple medical home recognition programs in the U.S., 5,739 practices representing 27,820 clinicians had received NCQA medical home recognition status as of May 2013.

Story Date: 
May 21, 2014
News Author: 
Chris Arenson, MD Eric Berman, DO Allan Crimm, MD Susan Day, MD Trudi Haecker, MD Don Liss, MD Nancy Meisinger Linda Siminerio, RN, PhD Linda Thomas, MD Bill Warning, MD Auren Weinberg, MD
Source Link: 
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Independence Blue Cross's primary care doctor network now has more than 300 'medical homes'

on Thu, 2014-05-15 00:00   lisabeth

Independence Blue Cross announces it has exceeded 300 recognized medical homes in its southeastern Pennsylvania network and now has one of the highest concentrations of medical homes in the nation. 

Independence was among the first and most ardent supporters of the region's first medical home program launched by the state of Pennsylvania in 2008. In 2010, six percent of Independence's membership was served by primary care doctors who had transformed their practices into medical homes. Today that number is 43 percent and continues to grow. 

Story Date: 
May 15, 2014
News Author: 
Ruth Stoolman
Source Link: 
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