March 12, 2012
By Tom Canty, Vice President and General Manager for Labor, Government and Special Accounts at Empire BlueCross BlueShield
Starting this summer, Empire BlueCross BlueShield will begin to implement a new patient centered primary care strategy which will offer primary-care doctors increased reimbursements – estimated at 10% — with the likelihood of additional payments increasing by as much as 50%. In addition, Empire will provide resources to enhance information sharing and provide clinical care management support.
Empire began rolling out patient centered medical home pilots in 2010. Based on the data we’ve collected, there’s reason to believe that primary care practices can be transformed such that health outcomes are improved, while costs are reduced. This new program will incorporate best practices from these medical home pilots, and build on their demonstrated value. For instance, our downstate of our New York pilot has shown an 12-23% percent decrease in acute inpatient admissions and a 11-17% percent decrease in total ER visits, while improving compliance with evidence‐based treatment and preventative care guidelines
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.
· Shared saving payments for quality outcomes and reduced medical costs.
National data shows that Primary Care Physicians, which include pediatricians, internists, general practitioners and family practice physicians, have income levels significantly lower than specialists, yet they are the glue in the medical system that ensures improved health outcomes and cost reduction associated with inconsistent, duplicative and fragmented care. This new program will help give primary care physicians new resources and the financial incentive to invest more time with patients and help develop a more comprehensive plan to live healthier lives. And, it will help lower overall health care costs.