Pilot Program Yields Success for BCBSOK Primary Care Providers
Tulsa, OK — The U.S. Department of Health and Human Services' Centers for Medicare & Medicaid Services (CMS) recently announced that the Greater Tulsa Region was the only participant, out of seven total, to achieve net savings in year two of the CMS Innovation Center's Comprehensive Primary Care Initiative (CPC). The CPC initiative offers reimbursement to primary care physicians over the course of four years, if they meet or exceed specific milestones.
In 2013, Blue Cross and Blue Shield of Oklahoma (BCBSOK), the largest private payer in the state, collaborated with CMS and other payers to offer Oklahoma-based primary care practices an opportunity to participate in the CPC initiative. This four-year, multi-payer pilot program challenges primary care physicians to transform their practices, resulting in improved health of their population, along with, better health care and lower medical costs, all which leads to improvement in the health status of Oklahoma. The program strongly focuses on reimbursing providers for the outcomes achieved for their patients. There were 64 practices selected by CMS to participate, encompassing 265 providers in the Greater Tulsa Region, which served approximately 140,000 Oklahomans.
This unique program is truly a collaboration between participating payers and one key to the success of the Greater Tulsa Region, is the integration of MyHealth Access Network , whose technology allows providers to have a broader access to the health history of the patients they are actively treating. MyHealth Access Network was chosen by CMS to be one of the three data aggregators across the nation and is also part of a bigger picture in transformation to outcomes- based medicine which serves as a health information exchange in Oklahoma.
Incentives for the primary care practices, including the opportunity to receive shared savings payments when quality metrics are achieved, became available the second year after the program was implemented. According to the CMS report, the Greater Tulsa Region generated a net savings of $10.8 million. Of the 64 Oklahoma clinics participating, 49 achieved the quality control standards needed to participate in the region’s potential shared savings for 2014.
"We believe the formula for the success of the Greater Tulsa Region CPC initiative is the collaboration among the payers, the engagement from the field service teams and the commitment of our participating providers to work together to support practice transformation which is improving health outcomes for our members," said Joseph R. Cunningham, M.D., Divisional Senior Vice President of Health Care Delivery and Chief Medical Officer at BCBSOK. "We are pleased to have joined forces with CMS and other payers on this project and it is rewarding to see the positive impact the CPC initiative is having on the overall health of our state. Together, we are making a difference in Oklahoma."
The success of the CPC pilot program in Tulsa is now being replicated with other BCBSOK primary care doctors across Oklahoma. BCBSOK will continue to encourage this collaboration to achieve long-term savings and improve health and wellness outcomes for our members.
For more information, visit www.innovation.cms.gov .
The following physicians are participating in the Greater Tulsa Region Comprehensive Primary Care initiative. Congratulations for your success in achieving positive outcomes for BCBSOK members through the Comprehensive Primary Care initiative.
Community Physicians Group
Dr. Christopher Klotz
Dr. Michael Gietzen
Doctors' names and practices are listed as they appear on https://innovation.cms.gov/initiatives/map