Program Details

Name of Payment Reform Program
  Accountable Care Arrangement
Organization Name
  Capital BlueCross
Program Contact Name
  Nick Guarneschelli
Program Contact Title
  Vice President, Health Care Provider Initiatives
Program Contact Email
Program Contact Phone
  717 703-8098
Program location(s)
  Only in this market
Market(s) (Ctrl-Click for multiple states)
Lines of business
  Self-insured commercial, Fully-insured commercial, Medicare
Stage of implementation
  Expansion mode (e.g. passed initial pilot stage and broadening reach)
Date of Implementation
  May 1, 2011
Payment reform model alignment
  FFS-based Shared-savings with quality
Base payment methodology
  FFS (includes discounted fees, fixed fees, indexed fees)
Participating provider types
  Primary care physicians, Other
Other types of providers
  We also include Primary Care Physician Extenders.
Related outcomes for policies on non-payment for specific services associated with complications that were preventable or services that were unnecessary
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 experience, Financial results
Type(s) of benefit and/or provider network design features that create member incentives or disincentives to support the payment reform program
Other features
  ACA Providers are given a Blue Provider Recognition through The Blue Cross Blue Shield Association (BCBSA) and Capital BlueCross. The BPR program does not serve as a measure of the actual quality of care provided. It designates that a provider participates in one or more of several quality programs recognized by BCBSA and/or Capital BlueCross, one of which is an Accountable Care Arrangement.
Information transparency
  We report to our network providers (e.g. hospitals and physicians)
Evaluation and results for program
  Program evaluation by insurer