Program Details

Name of Payment Reform Program
  Accountable Care Organization
Organization Name
  California Physician's Service, DBA Blue Shield of California
Program Contact Name
  John Hirschleifer
Program Contact Title
  Medical Director ACO in Hospitalist
Program Contact Email
  John .hirschleifer@blueshieldca.com
Program Contact Phone
  415-229-5999
Program location(s)
  Only in this market
Market(s) (Ctrl-Click for multiple states)
  CA
Lines of business
  Fully-insured commercial
Stage of implementation
  Expansion mode (e.g. passed initial pilot stage and broadening reach)
Date of Implementation
  January 1, 2010
Payment reform model alignment
  Shared-risk (other than bundled payment) and/or gainsharing with quality
Base payment methodology
  Capitation without quality
Participating provider types
  Primary care physicians, RNs/NP and other non-physician providers, Hospital inpatient
Other types of providers
  N/A
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
  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