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Home / News & IndustryManaged Care Insight and Analysis
Updated: April 20, 2010
Anthem Blues Singing Quality, Performance Tune In Colorado

Anthem Blue Cross and Blue Shield launched its P4P Quality-In-Sights Primary Care Incentive Program designed to evaluate and financially reward performance by eligible primary care physician group practices. The practices must meet identified industry measures of quality, appropriate pharmaceutical utilization, identified external recognitions and technology adoption, all aimed at enhancing patient care.

"Physicians want to provide the highest quality possible, but no one plays a game well if he can’t see the scoreboard," said Dr. Jay Want, president and CEO of Physician Health Partners. "Programs like Anthem’s give us tangible feedback tied to some of the funding necessary to build the systems to manage our performance."

Participating physicians must meet specific eligibility requirements and specialize in and designate their primary specialty as internal medicine, family practice or pediatrics.

The measures used are a combination of chronic disease, prevention measures, measures focused on pharmacy utilization, and technology adoption. The 2009 measures focus on chronic diseases: diabetes, asthma, coronary artery disease, primary preventative childhood and adolescent immunizations and well care visits.

"As healthcare reform is debated, several solutions have been identified as being critical to its success – improving the quality and safety of medical care is one of the essentials," said Dr. Art Jones,medical director, Anthem Blue Cross and Blue in Colorado. "Thirty percent of healthcare spending –estimated at $700 billion a year – is spent on tests, treatments and procedures that may provide no value and may actually harm patients."

The program’s measurement period is already underway and will end in October. Qualifying physicians’ practices will be rewarded through an adjustment to designated compensation beginning July 1, 2011 through June 30, 2012.

The program also includes voluntary reporting of nationally vetted and recognized evidence-based quality indicators in three categories: patient safety, patient health outcomes and member satisfaction.

It incorporates quality metrics and P4P incentives for important patient safety initiatives and operates under a transparent review process. The program also audits and externally validates the submitted hospital all-payer data, helping ensure the reporting hospital is promoting high-quality and safe healthcare for all patients.

It has identified nine performance dimensions against which it is measuring physician P4P.

In 2005, Anthem became the first Colorado health plan to introduce such a hospital healthcare quality program.

The majority of Colorado primary care physicians have partnered with Anthem to improve the safety and quality of healthcare, said John Martie, Anthem’s president.

Address: Anthem Blue Cross and Blue Shield, 700 Broadway, Denver, CO 80273; (303) 831-2077,

  This article was taken from:
Pay-For-Performance Reporter

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