Program Details

Name of Payment Reform Program
  Accountable Cancer Care Advanced Medical Specialties, Baptist Health, and Florida Blue
Organization Name
  Blue Cross Blue Shield of Florida
Program Contact Name
  Denise Mineo
Program Contact Title
  Senior Manager Network
Program Contact Email
  denise.mineo@bcbsfl.com
Program Contact Phone
  813-886-1663 ext. 27264
Program location(s)
  Only in this market
Market(s) (Ctrl-Click for multiple states)
  FL
Lines of business
  Self-insured commercial, Fully-insured commercial
Stage of implementation
  Pilot mode (e.g. only available for a subset of members and/or providers)
Date of Implementation
  January 1, 2014
Payment reform model alignment
  FFS-based Shared-savings with quality
Base payment methodology
  Other
Other base payment methodology
  The parties mutually agreed to financial and quality targets.
Participating provider types
  Primary care physicians
Related outcomes for policies on non-payment for specific services associated with complications that were preventable or services that were unnecessary
  N/A
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), Improvement over time of NQF-endorsed Outcomes and/or Process measures, PATIENT SAFETY (e.g., Leapfrog, AHRQ, medication related safety issues), Patient experience, Health IT adoption or use, Financial results, Utilization results, Pharmacy management
Type(s) of benefit and/or provider network design features that create member incentives or disincentives to support the payment reform program
  No active steerage
Information transparency
  We report to our network providers (e.g. hospitals and physicians)
Evaluation and results for program
  Program evaluation by insurer