More than 4000 Physicians Now Designated Patient Centered Medical Homes by Blue Cross Blue Shield of Michigan

Some 4,022 primary care doctors, have been designated as patient-centered medical homes for the 2014 program year by Blue Cross Blue Shield of Michigan.

The doctors are members of 1,422 physician practices that combined care for more than 1.2 million BCBSM members in 78 of Michigan’s 83 counties.

The program, in its sixth year, continues to lead the nation in size and cost savings, BCBSM said.

The health plan said it recorded certified savings of $155 million in prevented ER and hospital claims from the first three years of the PCMH designation program.  Savings estimates for year four are expected later this year.

“Data from 2013-2014 shows adult patients in Blue-designated PCMH practices had a 27.5 percent lower rate of hospital stays for certain conditions than non-designated practices,” BCBM said. Continue reading

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Driving Value-Based Reimbursement with Integrated Care Models

The burgeoning fee-for-value environment is rewarding networks of providers who collaborate and coordinate care, bridging the gap between health systems and physicians and sparking dialog and care compacts between primary care and specialists.

Even top-performing Pioneer ACOs are rethinking the role of specialists in care coordination.

Driving Value-Based Reimbursement with Integrated Care Models, a new report from the Healthcare Intelligence Network, examines WellPoint’s practice transformation effort and the reimbursement models that support it, while providing a framework in which to evaluate the patient-centered medical neighborhood (PCM-N) model.

Julie Schilz, director of care delivery transformation for WellPoint, and Terry McGeeney, MD, MBA, director of BDC Advisors, share their visions for this emerging care experience, from structuring incentives and reimbursement to rewarding high-quality and efficient care to identifying and engaging specialists in a medical home neighborhood.

Learn more about driving value-based reimbursement with integrated care models.

NEWS FACTS: This 45-page resource provides details on the following:

  • Three key practice transformation roles developed by WellPoint that address the critical elements of transformation;
  • How the physician practice transformation program complements WellPoint’s overall reimbursement strategy with fee-for-service and a shared savings component;
  • The Quality Gate for clinical and utilization metrics for WellPoint’s shared savings arrangement;
  • How to identify and engage specialists to participate in a medical neighborhood;
  • How to help physicians understand the link between meaningful use, the patient-centered medical home and medical neighborhoods;
  • Lessons learned in building medical neighborhoods;

and much more.

Learn more about driving value-based reimbursement with integrated care models.

Target Audience: Presidents/CEOs, CFOs, chief operating officers, vice presidents, medical directors, analysts, business development executives, consultants, directors, executive directors, financial/business managers, marketing executives, principals and strategic planning executives.

 

 

Transition to Medicaid Managed Long-Term Services and Supports: How Is It Going?

States are rapidly moving from fee-for-service to managed care for Medicaid long-term services and supports (LTSS).

An inventory conducted for the federal government found that the number of states using Medicaid Managed LTSS grew from 8 in 2004 to 16 in 2012, and an AARP Public Policy Institute study  shows 11 states planning to develop new Medicaid Managed LTSS programs in 2013.

Pros and Cons There are advantages as well as concerns about moving to capitated, risk-based managed care for Medicaid enrollees with LTSS needs.

For the full article click on:
http://blog.aarp.org/2013/08/16/the-transition-to-medicaid-managed-long-term-services-and-supports-how-is-it-going/

Take Your Corners – Hospital Health Plan Negotiation Strategies

Hospital managed care teams need to understand their markets are much more expansive than other hospital competition, advises, a senior exec with a company that provides a range of services to providers.

“Essentially, there are three basic ways of dealing with negotiation differences: Continue reading

Model of Highly Coordinated Care Begun By Aetna, Baptist Memorial Health Care

Employers and their workers will get access to what is described as highly coordinated care from physicians and facilities in the Baptist Select Health Alliance, under terms of a collaborative care agreement between Aetna and Baptist Memorial Health Care,  Memphis.

Aim of the collaboration is to bring a “new health care model” to Aetna members and introduce Aetna Whole HealthSM, a commercial health care product, officials said.

The Baptist Select Health Alliance is a clinically Continue reading

Bundled Payments May Be Another Developing Trend to Watch: Anthem Adopts Bundled Payment Agreements For Two Providers

Anthem BCBS has entered into “bundled payment” arrangements for select surgical procedures at the Orthopedic & Sports Institute of the Fox Valley in Appleton, Wis. and at Manitowoc Surgery Center in Manitowoc, Wis.

A “bundled payment” groups and coordinates all of the charges associated with a surgery and recovery together for one pre-negotiated price. This means an individual can quickly and easily understand their potential out-of-pocket costs before surgery and results in greatly reduced paperwork for all involved.

“Think of a bundled payment like a restaurant offering a complete meal for $20 deal,” said John Foley, regional Continue reading

Lessons From Florida – The Patient-Centered Medical Home: Statewide Rollout

A primary care focused pay-for-performance program at Florida Blue has been transitioned this year into a statewide patient-centered medical home initiative.

While the Recognizing Physician Excellence program (RPE) program had moved the bar on quality metric performance, the move to the PCMH provides a look at both the quality and efficiency factors of a patient’s care.

An under-the-hood look into the details of this successful new program will be presented during The Patient-Centered Medical Home: Lessons from a Statewide Rollout, a 45-minute webinar on May 10th at 1:30 pm Eastern, Barbara Haasis, R.N., CCRN, senior clinical lead, quality reward and recognition programs at Florida Blue, will share how the health plan transitioned from the RPE program into a medical home model.
She will share:

  •     Lessons learned from the first year of a PCMH pilot program and how this shaped the statewide rollout;
  •     The criteria for which physician practices were selected to participate in the program;
  •     The shared savings approach through which practices will be reimbursed;
  •     The role of a nurse educator in helping the practices transform;
  •     Reporting practice results to drive further improvement;
  •     Results in total cost of care from physicians originally enrolled in the pay-for-performance program, now in the first quarter of the PCMH.

For more information or to register, please contact call 800-516-4343 or click on this link now: http://store.hin.com/product.asp?itemid=4401