Empire BlueCross BlueShield to Launch Innovative Program to Enhance Primary Care by Paying Physicians More for Quality and Cost Improvements
Significant Investment in Primary Care Supports Physicians in their Efforts to Help Patients be Healthier
January 23, 2012 – New York, NY – Empire BlueCross BlueShield today announced plans for an innovative, patient‐centered primary care program that will fundamentally change its relationship with primary care physicians by increasing its investment in their practices to incentivize them to support patient health and reduce unnecessary costs.
Through this initiative, Empire will make a significant investment in primary care by increasing revenue opportunities for participating primary care physicians, enhancing information sharing, and providing care management support from Empire’s clinical staff.
“This is an important step in advancing the quality and affordability of health care. We know that the physician-patient relationship is the most important one in promoting health and wellness. As such, primary care is critical,” said Mark Wagar, president and CEO, Empire BlueCross BlueShield. “Our initiative aims to strengthen the relationship between doctors and their patients, while compensating primary care physicians more for making quality and cost effectiveness an everyday practice. We believe this will greatly benefit our members and the dedicated physicians with whom we work.”
The new program will also incorporate best practices from Empire’s successful medical home pilot, and build on the demonstrated value of those programs. For instance, one of our New York pilots have shown an 12-23% decrease in acute inpatient admissions and an 11-17% decrease in total ER visits for the pilot population, while improving compliance with evidence‐based treatment and preventative care guidelines.
“By better supporting physicians in managing many aspects of patient health, we strongly believe our members will receive higher quality health care and experience more optimal health outcomes, ” said John Caby, VP, Provider Engagement and Network Management at Empire. “Thanks to this program, primary care physicians will have some of the necessary resources, along with the financial incentive, to begin maximizing the potential of primary care to help our members live healthier lives.”
“This innovative program expands on the medical home concept and recognizes and rewards primary care doctors for their impact on improving health outcomes, said Dr. Gary S. Mirkin, CEO of Allied Pediatrics, which participates in Empire patient centered medical home program. “Thanks to Empire and its parent company, primary care physicians in New York will have some of the necessary tools to begin unleashing the true potential of primary care to provide higher quality services for our patients while responsibly reducing costs. It is my hope that other insurers will follow Empire’s lead so that every patient can have his or her own medical home.”
Through Empire’s new patient-centered primary care program, participating physicians will be able to earn additional revenue in the following ways:
| General increase to the regular fees paid to physician practices for specific services. |
| Payment for “non‐visit” services currently not reimbursed, with an initial focus on compensation for preparing care plans for patients with multiple and complex conditions. |
| Opportunity for shared saving payments for quality outcomes and reduced medical costs. |
To participate in the shared savings, physician practices must meet plan quality requirements, which include, for example, quality standards established by organizations such as the National Committee on Quality Assurance, the American Diabetes Association, the American Academy of Pediatrics and others. Those primary care physicians, however, who maintain or improve quality may earn 30 percent to 50 percent more than they earn today through the shared savings model. Over time, Empire estimates the program could substantially improve quality and member health, potentially reducing trend in overall medical costs by as much as 20% by 2015.