Independence Blue Cross to Participate in New Nationally Funded Pilot to Advance Primary Care
Pilot to improve care for chronically ill is among first to come from health care law
Philadelphia, PA - November 16, 2010 - Independence Blue Cross announced today its participation in a new local pilot program created by the Centers for Medicare & Medicaid Services (CMS) to improve primary care among the elderly. The program, known as Advanced Primary Care pilot, is one of the first initiatives aimed at improving the quality and lowering the cost of health care to emerge from the new federal health care reform law.
The federal pilot expands Pennsylvania's Chronic Care Collaborative, a three-year patient-centered medical home initiative launched in southeast Pennsylvania in 2008, and provides an additional $33 million in federal funding for participating physicians treating Medicare beneficiaries.
Medical homes are relatively new models of care that bring a personalized team approach to the primary care physician's practice by better coordinating and organizing care, especially for patients with chronic conditions. This includes scheduling a patient to see a doctor as soon as a problem develops and employing care managers and health educators to help chronically ill patients receive key tests, take medication, and stay well.
Primary care physicians who have adopted this model of care report being more professionally satisfied and achieving superior results.
Pennsylvania is one of only eight states selected by CMS to participate in the federal pilot, which begins next spring. The program in southeastern Pennsylvania currently includes more than 220,000 patients - including more than 100,000 IBC members - receiving care from 150 physicians in 32 primary care practices. The CMS Innovation Center is charged with examining new ways of delivering and financing health care with the goal of improving health outcomes and containing costs.
"We understand that our current system of health care is fragmented and care is not coordinated among different health providers as well as it should be, nor are patients armed with the right tools and resources to stay healthy. We are proud to be a part of the solution to help strengthen the role these doctors serve in today's changing health care environment," says Dr. Richard Snyder, IBC's chief medical officer and co-chair of Pennsylvania's Chronic Care Commission. "We've long supported collaborations with the government, physicians, hospitals, and other health care providers to improve cost and quality for patients and look forward to their continued participation in quality initiatives like this."
Background on Pennsylvania's Chronic Care Collaborative
The Chronic Care Collaborative is a multi-stakeholder initiative created by the state's Chronic Care Commission. It includes a number of health plans, physicians, and the PA Governor's Office of Health Care Reform. To date, all 32 participating practices have successfully achieved recognition as medical homes by the National Committee for Quality Assurance (NCQA), a private, not-for-profit organization dedicated to improving health care quality. The NCQA has determined various levels of achievement the practices must meet to earn additional reimbursement by the participating health plans. From 2008 to 2010, the pilot has achieved the following results for three significant health measures in diabetics:
- Patients with A1C (blood sugar level) greater than 9: decreased from 33 percent to 27 percent to 24 percent; (An A1C level of less than 7 is considered optimal for diabetics.)
- Patients with LDL (so-called bad cholesterol) less than 130: increased 36 percent to 62 percent to 69 percent;
- Patients with systolic blood pressure lower than 140: increased from 57 percent to 69 percent to 75 percent.
IBC's broader efforts to reimburse physicians for better primary care
In July of 2010, IBC invested nearly $47 million to improve primary care medicine and advance the medical home model as part of its payment program to its network of physicians. Now, IBC is working with area hospitals in a rollout of its new, enhanced incentive plan for hospitals and specialists designed to reward providing better coordinated, higher quality, and more cost-effective care. IBC calls this new plan to increase pay for improved performance the Integrated Provider Performance Incentive Plan (IPPIP). IPPIP replaces the current pay-for-performance program in IBC's hospital contracts upon the renewal of each contract.
Dr. Snyder adds, "We're convinced that better organized and coordinated primary care means better quality and health outcomes for patients and less wasteful spending of the health care dollar. We are committed to working together with innovative and committed physicians, specialists, hospitals, and clinicians to create a foundation on which they may deliver better care, not more care."
About Independence Blue Cross
Independence Blue Cross is a leading health insurer in southeastern Pennsylvania. Nationwide, Independence Blue Cross and its affiliates provide coverage to nearly 3.3 million people. For more than 70 years, Independence Blue Cross has offered high-quality health care coverage tailored to meet the changing needs of members, employers, and health care professionals. Independence Blue Cross's HMO and PPO health care plans have consistently received the highest ratings from the National Committee for Quality Assurance. Independence Blue Cross is an independent licensee of the Blue Cross and Blue Shield Association