Posts Tagged ‘medical home neighborhood’

BCBS Michigan PGIP Value Partnership Translates to Quality Improvement, Cost Savings

May 6th, 2014 by Patricia Donovan

Donna Saxton: BCBSM's PGIP has resulted in primary care-specialist collaborations that improved care coordination and reduced unnecessary utilization and spend.

Blue Cross Blue Shield of Michigan’s Physician Group Incentive Program (PGIP) is so studded with acronyms it’s almost a separate language, jokes Donna Saxton, BCBSM’s field team manager of BCBSM’s value partnerships program.

And while not everyone speaks PGIP-tian, it’s easy to translate the savings and benefits the medical home reward and incentives program portends for the insurer, its PCMH practices and its health plan members.

Ms. Saxton described PGIP’s place in BCBSM’s Value Partnerships program during Generating Medical Home Savings and Quality Improvements Through Outcome-Based Measures, including the structure of rewards and incentives that have produced results for the plan, which operates the largest network in Michigan.

“PGIP incentivizes providers to enhance the delivery of care by encouraging them to be responsible and proactive in their behaviors, and ultimately driving better health outcomes and also increasing the fee for value that we also desperately need to get to,” said Ms. Saxton.

In return, BCBSM provides financing tools and support for the nearly 18,500 primary care physicians and specialists who participate—more than half of BCBSM’s physician population.

Aimed at some root causes of high cost healthcare, including a weak primary care foundation, PGIP, which Ms. Saxton described as the organization’s “pinnacle” initiative, expects physician organizations (POs) to take responsibility for developing systems of care, motivating its physicians from within and adopting a culture of process improvement. In return, BCBSM places resources and a PGIP field team representative at the POs’ disposal.

Some PGIP activities eligible for incentives range from e-prescribing and patient registries to specialist referrals and medical homes‘ linkage to community services, Ms. Saxton explained. Further, BCBSM has amped up three key medical home initiatives for its organized systems of care (OSC), “putting them on steroids,” as Ms. Saxton said, to raise the performance bar and offer more chances for POs to earn incentives.

BCBSM coined the term OSC, which, while conceptually aligned with the goals of an accountable care organization (ACO) is designed to give providers more latitude in detemining their priorities, she noted. “The OSC is where the neighborhood concept comes into play, where you focus on implementation of PCMH neighborhood capabilities in your specialty offices to further address fragmented care.” BCBSM specialists are eligible for one-time incentives plus enhanced fees for collaboration with primary care practices.

A counterpart to PGIP incentives is the PGIP PCMH designation program, an opportunity for practices to earn BCBSM’s internally developed medical home designation and the added incentives that go with that distinction, such as increased reimbursement for PCMH office visits. The designation comprises 140 capabiities across a dozen areas.

To date, the biggest challenge of PGIP appears to be its extended access initiative, but practices who adopt more open scheduling often have much lower rates of ED and radiology utilization, noted Ms. Saxton.

Connectivity is also an issue for some, especially practices in rural areas of the state or organizations that have not yet adopted EHRs, which will ultimately be required for participation.

Compared to non-BCBSM-designated PCMHs, the organization’s medical homes have produced some significant results, including an 11.2 percent decrease in primary-care related ED visits and a 6.7 percent reduction in low-tech radiology usage.

Ms. Saxton shares more on physician incentives and rewards and some outstanding primary care collaborations that have resulted from the engagement of specialists in BCBSM’s medical home program in this audio interview.

HINfographic: The Medical Home Neighborhood

November 18th, 2013 by Jackie Lyons

There are more than 6,037 PCMH sites in the United States, according to the NCQA. To further reduce fragmented care, many PCMHs are expanding to house the entire care continuum – a phenomenon known as the Medical Neighborhood.

Medical home neighbors include specialists along with primary care clinicians to better coordinate care, according to a new infographic from the Healthcare Intelligence Network. This HINfographic also includes successful tactics for medical home ‘neighbors,’ signs of a desirable medical neighborhood and medical home neighborhood advice and comments from actual healthcare organizations.

The Medical Home Neighborhood

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Information presented in this infographic was excerpted from: Medical Home Neighborhoods: Uplinking Specialists To Create Integrated Systems of Care. If you would like to learn more about medical home neighborhoods, this resource includes even more information, including how to help physicians understand the link between meaningful use, care coordination across the neighborhood, and detailed lessons learned in building medical neighborhoods.

Have an infographic you’d like featured on our site? Click here for submission guidelines.

WellPoint ‘Leaves No Primary Care Practice Behind’ on Road to Value-Based Payment Reform

November 4th, 2013 by Patricia Donovan

To foster its ambitious goal of moving 75 percent of its physician practices from visit- to value-based reimbursement over the next three years, WellPoint has placed a variety of resources at the practices’ disposal.

Building on its successes with the patient-centered medical home, a model it has deployed since 2008, WellPoint is transitioning its practices from a fee-for-service world to one that rewards doctors when they improve both the quality and affordability of the care they provide. The payment reform starts with a care coordination fee for activities that are not “visit”-based. Once physicians meet an established quality gate, they are eligible to share in any savings achieved.

Supports for providers in WellPoint’s 14 markets as they transition to the new payment system are designed to meet the needs of all its practices, explains Julie Schilz, director of care delivery transformation for WellPoint — from small individual practices to large integrated health systems.

“We have a ‘Leave No Primary Care Practice Behind’ philosophy,” said Ms. Schilz. “Some practices have wonderful systems or enhanced capabilities, like a Patient-Centered Medical Home recognition. How we bring ourselves to these practices certainly looks different than [our presentation to] a practice just starting on its transformation journey.”

Resources range from toolkits, Web-based care delivery software and a learning collaborative that offers live and recorded training sessions and virtual “call-in” hours to access to three consultants with distinct areas of expertise.

During a recent webinar on Aligning Value-Based Payment with Physician Practice Transformation, Ms. Schilz described how the three consultants assist the practices virtually, via site visits or by curating content for the learning collaborative:

  • The Provider Clinical Liaison helps practices develop essential care coordination and care management skills, such as developing a care plan, and also acts as the interface between the primary care provider and WellPoint.
  • The Community Collaboration Manager helps providers make sense of reports and data and get on track for transformation, while contributing to learning collaborative content.
  • The Patient-Centered Care Consultant works with practices to boost quality improvement efforts and connect providers to community tools and resources.

To maximize a practice’s financial rewards, providers must routinely mine patient data to identify opportunities to improve care. WellPoint’s nine separate reports available to care teams tabulate everything from no-longer-active patients to a practice’s “hot spotters” — patients at risk of readmission or whose chronic illness history turns up glaring care gaps.

While primary care practices acclimate to the new payment model, WellPoint is simultaneously participating in Comprehensive Primary Care initiatives in four states, a program whose value-based focus meshes well with WellPoint’s ongoing payment transformation.

Calling patient-centered care “the new normal,” Ms. Schilz said WellPoint is also laying the foundation for construction of medical home neighborhoods. Expected to launch in 2014: WellPoint’s first iteration of patient-centered specialty care (PCSC). This limited venture, which encompasses four key areas, will expand care coordination to a few willing specialties: cardiology, endocrinology and OB-GYN.

“We will start the dialogue between specialists and primary care to talk about how we assure that our patients are flowing back and forth from our offices in an effective way.”

Click here to listen to an interview with Julie Schilz.