Provider Value-based Performance Programs

Independence Blue Cross (Independence) offers a variety of value-based performance programs that incentivize providers for high quality and cost-effective care. These programs are congruent with Independence’s strategy of augmenting patient-centered care through the alignment of provider incentives and promotion of the vertical integration of hospitals, specialists, and primary care physicians. Below is an overview of the programs currently offered by Independence.

QIPS

The Quality Incentive Payment System (QIPS) program was developed to offer primary care practices incentives for effectively managing the care of both HMO and PPO populations, including the management of National BlueCard® PPO members. Effective 2016, QIPS is also recognized as a Blue Distinction Total CareSM (BDTC) program by the Blue Cross and Blue Shield Association (BCBSA), an association of independent Blue Cross and Blue Shield plans.

The chart below identifies the incentive programs applicable to the PPO and/or HMO components of QIPS. These programs reward providers for achieving high quality standards while maintaining cost-effective care within their practices.

Program components
HMO
PPO
Quality Performance Measure (QPM) score program
X
X
Total Cost Efficiency
X
X
Generic Drug Prescribing
X
 
Care Efficiency Management
 
X

For more information on the QIPS program, providers can log on to the NaviNet® web portal and read the QIPS Program Manual found under Current Publications.

PCAM

CMS selected Independence as a payer partner in the Greater Philadelphia region for Bucks, Chester, Delaware, Montgomery, and Philadelphia counties. As a result, Independence created the Primary Care Advancement Model (PCAM) for our participating providers who are also selected by CMS to participate in CPC+. PCAM is based on Independence's QIPS program and is adapted for CPC+.

PCAM offers primary care practices incentives for providing quality health care and effectively managing the care of their HMO and PPO populations, including the management of National BlueCard PPO members. PCAM is also recognized as a BDTC program by the BCBSA.

The chart below identifies the incentive programs applicable to the PPO and/or HMO components of PCAM. These programs reward providers for achieving high quality standards while maintaining cost-effective care within their practices.

Program components
HMO
PPO
Quality Performance Measure (QPM) score program
X
X
Total Cost Efficiency
X
X
Generic Drug Prescribing
X
 
Care Efficiency Management
 
X

For more information on the PCAM program, providers can log on to NaviNet and read the PCAM Program Manual found under Current Publications.

Accountable Care Organization (ACO) Payment Model

Independence’s ACO payment model is an accountable care payment model designed to encourage provider integrations and improved care collaboration across the delivery system (hospitals, primary care physicians, specialists, and other health care providers). The ACO payment model requires health care providers to promote formal integration of a hospital and its medical staff with a focus on improving clinical performance and cost efficiency for the care delivered to their population. The accountable care payment model has been embraced by more than 90 percent of the health care delivery systems in the region.

Specialist and Other Value-based Performance Programs

Independence has developed a variety of value-based performance programs for specialty and ancillary providers designed to promote quality improvement and cost-efficiency in those specific domains. Cardiology, oncology, urology, women’s health, skilled nursing, and home health are among the types of specialty programs currently in place.