Sunday, February 26, 2012

Age of Primary Care has arrived: enhanced reimbursement announcements

I guess this what happens when Geeks and Primaries are working together.
HIT and PCMH have generated the evidence for enhanced reimbursement. sv

Here are the announcements from Aetna, Anthem and United.

Aetna (CT/NJ):

Primary care providers who participate in Aetna’s networks, who have been recognized by the National Committee for Quality Assurance (NCQA)* as a PCMH, and who are not participating in other quality incentive programs with Aetna will receive a quarterly Coordination of Care payment for each commercial (non-Medicare) Aetna member in their care. The NCQA-recognized PCMH practices are recognized for providing a number of services, including:

Improved access to care, such as the ability to reach health professionals outside normal business hours;
Proactive and planned preventive care (screenings, physicals, labs);
Improved access through non-face-to-face visits (e-mail, web, phone); and
Access to nurses and other health care professionals, allowing more focused physician visits.

According to the Wall Street Journal, the reimbursement could be an extra $2-$3 per patient per month.

Anthem (NY):

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.

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.

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