Program Details

Name of Payment Reform Program
  Accountable Care Organization (ACO)
Organization Name
  Blue Cross and Blue Shield
Program Contact Name
  Sandra Skinner
Program Contact Title
  Sr. Manager, Key Accounts
Program Contact Email
  sandra_skinner@bcbsil.com
Program Contact Phone
  (312) 653-7965
Program location(s)
  In this market and other markets
Market(s) (Ctrl-Click for multiple states)
  AZ, AR, CA, CO, CT, DE, DC, FL, GA, HI, ID, IL, IN, IA, KS, KY, LA, ME, MD, MA, MI, MN, MT, NH, NJ, NY, NC, ND, OH, OR, PA, RI, SC, TN, TX, UT, VT, VA, WA, WV, WI, WY
Lines of business
  Self-insured commercial, Fully-insured commercial
Stage of implementation
  Full implementation (e.g. available to all intended/applicable providers and members)
Date of Implementation
  January 1, 2010
Payment reform model alignment
  Other
Other non-FSS based reform models
  Payment model varies by each market; however, can include methods such as shared-risk, FFS plus pay for performance, non-payment policy for specific services and other non-FFS based payment reform models.
Base payment methodology
  Other
Other base payment methodology
  Base payment varies by market; however, can include FFS and DRG.
Participating provider types
  Primary care physicians, Hospital inpatient, Other
Other types of providers
  Each market structures their program differently; collectively and across the system, Blue Plans participate in the selected arrangements.
Related outcomes for policies on non-payment for specific services associated with complications that were preventable or services that were unnecessary
  Healthcare acquired conditions (HACs) also known as hospital-acquired conditions, Preventable Admissions, Never Events, Other
Other outcomes referenced
  Each market structures their program differently; collectively and across the system, Blue Plans participate in the selected arrangements.
Performance measures used
  Achievement (relative to target or peers) of Clinical process goals (e.g., prophylactic antibiotic administration, timeliness of medication administration, testing, screenings), Achievement (relative to target or peers) of Clinical outcomes goals(e.g., readmission rate, mortality rate, A1c, cholesterol values under control), PATIENT SAFETY (e.g., Leapfrog, AHRQ, medication related safety issues), Application of specific medical home practices (e.g., intensive self management support to patients, action plan development, arrangement for social support follow-up with a social worker or other community support personnel), Other
Other performance measures
  Each market structures their program differently; collectively and across the system, Blue Plans participate in the selected arrangements.
Type(s) of benefit and/or provider network design features that create member incentives or disincentives to support the payment reform program
  Use of tiered/high performance or narrow networks, Objective information (e.g., performance measure results) provided on COEs to members, providing evidence of higher-quality care rendered by these providers, No active steerage, Other
Other features
  Each market structures their program differently; collectively and across the system, Blue Plans participate in the selected arrangements. We also encourage members to use our Blue Distinction Center (BDC) facilities through a combination of hard steerage (e.g., benefit differentials) and soft steerage where we use member interactions to encourage members to seek care at designated facilities.
Information transparency
  We report to the general public, We report to our network providers (e.g. hospitals and physicians), We do not report performance on quality measures, Other
Other information transparency
  Each market structures their program differently; collectively and across the system, Blue Plans participate in the selected arrangements.
Evaluation and results for program
  Program evaluation by insurer, Evaluation method used pre/post, Evaluation method used matched control group