BlueCross BlueShield of Alabama Primary Care Value Based Payment Program
Program Location:
Montgomery, AL
Number of Practices:
14
Payer Type:
Commercial
Parent Program:
Payers:
BlueCross BlueShield of Alabama
Reported Outcomes
Description:
In 2009, BlueCross BlueShield of Alabama launched a medical home pilot program, which aimed to positively enhance the delivery and quality of patient care, improve patient engagement in their own care, result in overall improved patient outcomes and encourage reimbursement and benefit designs that support the practice of primary care. The pilot consisted of three phases from September 2009 to December 2011. Fourteen physician practices were chosen and represented a large mix of populations, both urban and rural, several specialties, and different patient populations and practice sizes who utilized multiple practice management tools and technologies. All primary care physicians that met basic requirements were eligible to participate and earn reward payments. NCQA medical home recognition was included as a criteria measure for the practices and a "Medical Home Support Team" collaborated with providers throughout the process to provide ongoing technical support and encouragement to providers. This support team consisted of clnicians, health managment professionals, provider representatives and experts in health information technology.
After the completion of the medical home pilot program, Blue Cross Blue Shield of Alabama launched the Value Based Payment (VBP) Program in January 2011, which initially targeted the following primary care specialties: Geriatrics, Family Practice, Internal Medicine, General Practice and Pediatric Medicine. The VBP program allows practices with NCQA PCMH or Diabetes Recognition to earn points toward value-based payment within the Administrative category requirement.
Payment Model:
2014 Primary Care value-based payment terms and conditions:
Qualification for the 2014 Primary Care Value-Based Payment (VBP) Program is based on three performance measure categories: Efficiency, Administrative (Qualitative) and Effectiveness of Care (Quantitative). Within each category (outlined below), multiple criteria will be measured to determine if physicians meet the point threshold to earn a cumulative increase based on all medical and surgical codes [not including codes for laboratory services, durable medical equipment (DME), drugs, radiology, and other commodity services]. A list of these codes is available through ProviderAccess. Select “Value-Based Procedure Reimbursement Codes” under Fee Schedules. Scores for performance measures listed within each category are combined to determine the overall value-based payment score for a category. A minimum overall score of 70 is required to qualify for a performance category. The maximum reward possible is 20%.
Fewer ED / Hospital Visits:
- Fewer hospital days (2009-2011 PCMH Pilot)
- Fewer ED visits (2009-2011 PCMH Pilot)
Improved Patient/Clinician Satisfaction:
- Overall improvement in patient satisfaction (2009-2011 PCMH Pilot)
Cost Savings:
- Estimated cost savings of $1.9 million (2009-2011 PCMH Pilot)
Increased Preventive Services:
- 13.6% higher rate of colorectal cancer screenings v. network average (2009-2011 PCMH Pilot)
- 11.8% higher rate of breast cancer screenings v. network average (2009-2011 PCMH Pilot)
- 13.8% higher rate of appropriate testing of children with pharyngitis v. network average (2009-2011 PCMH Pilot)
Data Source(s):
Last updated March 2019
