Program Details

Name of Payment Reform Program
  Accountable Care Organization John Hirshleifer Medical Director, ACO 415-229-5999
Organization Name
  California Physician's Service, DBA Blue Shield of California
Program Contact Name
  John Hirshleifer
Program Contact Title
  Medical Director, ACO
Program Contact Email
Program Contact Phone
Program location(s)
  Only in this market
Market(s) (Ctrl-Click for multiple states)
Lines of business
  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
  Non-FFS-based Shared-savings with quality
Base payment methodology
Other base payment methodology
  Our ACO financial model is a hybrid between FFS, capitation, and a risk share.
Participating provider types
  Primary care physicians, RNs/NP and other non-physician providers, Hospital inpatient
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, Serious Reportable Events (SREs) that are not HACs, Never Events
Performance measures used
  Appropriate maternity care, Longitudinal efficiency relative to target or peers, 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), 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
Other features
  We are currently designing an ACO HMO product which will provide consumers and employers with a greater opportunity to leverage our high-value ACO providers and the integrated care, wellness programs and deep clinical integration that our ACOs provide.
Information transparency
  We report to our network providers (e.g. hospitals and physicians)
Evaluation and results for program
  Program evaluation by insurer