Blue Access for Producers

Blue Cross and Blue Shield of Oklahoma Participates in National CMS Initiative

November 7, 2012

The Greater Tulsa Region was selected as one of seven regions across the nation to participate in a new initiative coordinated by Centers for Medicare & Medicaid Services' Center for Medicare and Medicaid Innovation (CMS). This Comprehensive Primary Care  initiative will offer value-based care reimbursement to primary care physicians over the course of four years.

This program is unique in that it is a collaboration of multiple payers — CMS, Oklahoma Health Care Authority and insurers like Blue Cross and Blue Shield of Oklahoma. Another participating organization is the MyHealth Access Network , a community health information exchange, whose technology will enable the Comprehensive Primary Care initiative to come to life. MyHealth is also part of a bigger picture, serving as a health information exchange throughout the state of Oklahoma. MyHealth Access Network is one of a select few national sites receiving a three year federal Beacon Community Award from the Office of the National Coordinator for Health Information Technology.

The Comprehensive Primary Care initiative is similar, but not identical, to Health Care Service Corporation's (HCSC) value-based care models. In effect, it can be considered a hybrid between HCSC's extended medical home (EMH) and intensive medical home (IMH). It is unique in that there are no age restrictions, and there are fewer restrictions around the use of the provider's supplemental income. Providers receive risk-adjusted supplemental payments in the form of per member per month, and a shared savings program will be in effect after Year 2.

There were 68 practices selected by CMS to participate, encompassing 265 providers in the Greater Tulsa Region. Currently, approximately 18,000 fully-insured Blue Cross and Blue Shield of Oklahoma members have been selected to participate. FEP has already shown intent to participate, and ASO groups will be recruited in 2013.

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