New York health plan among those to test key investment in coordinated care
<0> Empire BlueCross BlueShieldKim Ashley, (513) 445-0191 </0>
Empire BlueCross BlueShield today announced that more than 280 physicians working with 75 practices in New York’s Capita District-Hudson Valley have been selected to participate in a groundbreaking initiative to advance primary care and improve the accessibility and affordability of quality health care through a partnership with the Centers for Medicare & Medicaid Services (CMS).
CMS has selected 500 primary care practices in seven regions to participate in its Comprehensive Primary Care (CPC) initiative, a new partnership between payers including CMS, state Medicaid agencies, commercial health plans and self-insured businesses, and primary care providers. The partnership is designed to promote improved access to quality health care at lower costs. Empire’s parent company is working with nearly 900 providers selected to participate in the partnership across its affiliated health plans in Colorado, Kentucky, Ohio and New York.
Through the CPC program, CMS will pay primary care practices a care management fee, initially set at an average of $20 per beneficiary per month, to support enhanced, coordinated services on behalf of Medicare fee-for-service beneficiaries. Simultaneously, participating commercial, state, and other federal insurance plans are also offering enhanced payment to primary care practices that are designed to support them in providing high-quality primary care on behalf of their members.
“We’re pleased that many New York physicians in the Capital District-Hudson Valley who work with us have been chosen for this pioneering initiative,” said Dr. Scott Breidbart, Chief Medical Officer for Empire BlueCross BlueShield. “Empire and CMS are aligned in our commitment to improve the accessibility and affordability of quality health care for all Americans, and we believe the CPC initiative represents a significant means by which we will achieve this. Empire supports a patient-centered, primary care practitioner approach to health care delivery. For example, we’ve already seen successes in improving the quality of health care from earlier New York-based pilot programs with the same patient-centered approach.”
For patients, the CPC initiative means participating physicians are encouraged to offer longer and more flexible hours; use electronic health records; coordinate care with patients’ other health care providers; better engage patients and caregivers in managing their own care; and provide individualized, enhanced care for patients living with multiple chronic diseases and higher needs.
“The Comprehensive Primary Care initiative is the kind of common-sense investment in health care we need,” said Health and Human Services Secretary Kathleen Sebelius. “Businesses, families, and taxpayers all benefit from a stronger primary care system that helps to improve our health and lower costs.”
The initiative started in the fall of 2011 with CMS soliciting a diverse pool of commercial health plans, state Medicaid agencies, and self-insured businesses to work alongside Medicare to support comprehensive primary care. Public and private health plans in Arkansas, Colorado, New Jersey, Oregon, New York’s Capital District-Hudson Valley region, Ohio and Kentucky’s Greater Cincinnati-Dayton region, and the Greater Tulsa region of Oklahoma signed letters of intent with CMS to participate in this initiative. The markets were selected in April, 2012 based on the percentage of the total population covered by payers who expressed interest in joining this partnership.
Eligible primary care practices in each market were invited to apply to participate and start delivering enhanced health care services in the fall of 2012. Through a competitive application process, primary care practices within the selected markets were chosen to participate in the Comprehensive Primary Care initiative. Practices were chosen based on their use of health information technology, ability to demonstrate recognition of advanced primary care delivery by leading clinical societies, service to patients covered by participating payers, participation in practice transformation and improvement activities, and diversity of geography, practice size, and ownership structure. CMS estimates that more than 300,000 Medicare beneficiaries will be served by over 2,000 providers through this initiative.
“Primary care practices play a vital role in our health care system and we are looking at ways to better support them in their efforts to coordinate care for their patients,” said Acting CMS Administrator Marilyn Tavenner.
The CPC initiative aligns and shares a foundation with Empire’s patient-centered primary care initiative to significantly strengthen the role of primary care through added financial incentives and resources. Empire announced its program earlier this year and has worked closely with CMS and others on the CPC effort.
The CPC initiative is a four-year initiative administered by the Center for Medicare and Medicaid Innovation (CMS Innovation Center). The CMS Innovation Center was created by the Affordable Care Act to test innovative payment and service delivery models that have the potential to reduce program expenditures while preserving or enhancing the quality of care.
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Serving New Yorkers for over 75 years, Empire BlueCross BlueShield is the largest health insurer in New York supporting nearly six million members and more than 38,000 business, union and small employers in New York. Empire BlueCross BlueShield (Empire) is the trade name of Empire HealthChoice Assurance, Inc., and Empire Blue Cross Blue Shield HMO is the trade name of Empire HealthChoice HMO, Inc., independent licensees of the Blue Cross Blue Shield Association, serving residents and businesses in the 28 eastern and southeastern counties of New York State. Additional information about Empire is available at . Also, follow us on Twitter at , on Facebook at , or visit our YouTube channel at .