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

What is Being Thrown into Your Healthcare Reimbursement Stew: All with a Goal of Care Improvement

Bundled payments, new models of reimbursement, care transitions, value-based reimbursement, readmission penalties, are all part of the jargon in payer and provider circles today.

And there is no lack of opinions on what new or a combination of all is the answer to quality care, cost savings and outcomes results. All approaches come with some risks to providers and financially to payers.

On the eve of the new year, the Centers for Medicare & Medicaid Services (CMS) released the health care organizations selected to participate in  the Bundled Payments for Care Improvement initiative, an innovative new payment model.

“Under the Bundled Payments for Care Improvement initiative,” organizations will enter into payment arrangements that include financial and performance accountability for episodes of care. These models may lead to higher quality, more coordinated care at a lower cost to Medicare,” CMS said. Continue reading

What is Being Thrown into Your Healthcare Reimbursement Stew: All with a Goal of Care Improvement

Bundled payments, new models of reimbursement, care transitions, value-based reimbursement, readmission penalties, are all part of the jargon in payer and provider circles today.

And there is no lack of opinions on what new or a combination of all is the answer to quality care, cost savings and outcomes results. All approaches come with some risks to providers and financially to payers.

On the eve of the new year, the Centers for Medicare & Medicaid Services (CMS) released the health care organizations selected to participate in  the Bundled Payments for Care Improvement initiative, an innovative new payment model.

“Under the Bundled Payments for Care Improvement initiative,” organizations will enter into payment arrangements that include financial and performance accountability for episodes of care. These models may lead to higher quality, more coordinated care at a lower cost to Medicare,” CMS said. Continue reading

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.

 

 

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

New: Medicare Pioneer ACO: Case Study on Atrius Health’s Focus on the Triple Aim

By applying an “ACO magnifying glass” to high-risk patients and high-cost events, and using an organizational background in rapid cycle improvement, Atrius Health has developed focused interventions to
hit Triple Aim goals within their Medicare’s Pioneer ACO model. Continue reading

Just Released: Guide to Embedded Case Management

Guide to Embedded Case Management

 Care coordination is at the core of value-based healthcare delivery models like the patient-centered medical home and the accountable care organization (ACO).

Healthcare case managers embedded within the physician delivery system help to put a face on care coordination while reducing readmissions and improving quality of care for high-risk populations such as dual eligibles. Continue reading

Just Released: Guide to Embedded Case Management

Guide to Embedded Case Management

 Care coordination is at the core of value-based healthcare delivery models like the patient-centered medical home and the accountable care organization (ACO).

Healthcare case managers embedded within the physician delivery system help to put a face on care coordination while reducing readmissions and improving quality of care for high-risk populations such as dual eligibles. 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

Inside Report: IPAs – PHOs Definitely Worth Another Look

Independent practice associations (IPAs) and physician hospital organizations (PHOs) have risen to a prime position in the healthcare provider market, especially in recent months.

Imagine physician organizations were written off for dead just a few years ago. Impatient for successful results, hospitals and physicians were shutting down their PHO partnerships.

The smaller IPAs just faded away – just another healthcare ‘gimmick.’ A failed idea.

So the overall numbers of physician organizations has shrunk in terms of numbers of organizations, according to our research results for the National Directory of Physician Organizations Database, produced by the Managed Care Information Center.

But the PHOs and IPAs with sharp leadership stuck with it. And, today they are stronger and importantly positioned to be significant players in today’s changing provider arena.

First the major IPAs across the country proved that they were indeed viable. Led by sharp executives and leadership, patients and health plans and their members came.

“If you build it they will come.”

After a few battles with the federal trade commission physician organizations got the FTC’s green light for clinical integration initiatives.

The exploding wave of pay-for-performance programs reinforced that IPA and PHO member physicians could ramp up their quality of care measures and patient satisfaction numbers.

Because of the success of IPAs, there has also been a wave of consolidation further strengthening their position in the marketplace.

Health and managed care executives have told us about what’s shaping today’s market.

“Health Reform…it is changing the entire playing field; Significant changes in the relationships between payors, providers and patients due to health reform; tiered networks that exclude academic medical centers; Continuing movement from government and payors to P4P programs (heavy emphasis on quality); and, P4P will be easier for large carriers to implement than any real payment reform,” were among just a few of the observations shared by participants in the Managed Care Leadership Survey.

Now, even as rules governing accountable care organizations have just been proposed by the Centers for Medicare and Medicaid Services (CMS) physician organizations in several sections of the country have been out-of-the-gate first.

Physician organizations now have as physician members a major number of the practicing primary care and specialist physicians in the country.

And, as they continue to bulk up, physician organizations are having to upgrade their infrastructure, IT systems, and processes.

A rising tide does indeed float all boats; at least the IPA and PHO crafts.

Bob Jenkins

Bob Jenkins is the CEO of the Managed Care Information Center.

Research source: The National Directory of Physician Organizations Database

http://www.healthresourcesonline.com/payer-provider-data/the-national-directory-of-physician-organizations-database-on-cd-rom.html

Copyright 2011, The Managed Care Information Center, 1913 Atlantic Avenue, Ste 200, Manasquan, NJ 08736  (800) 516-4343