|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
"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
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
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
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, www.anthem.com.