Anthem Blue Cross and Blue Shield in Ohio Announces Physician Practices to Participate in Historic Public-Private Partnership to Strengthen Primary Care

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<0> Anthem Blue Cross and Blue ShieldMedia Contact:Kim Ashley, (513) 445-0191 </0>

Anthem Blue Cross and Blue Shield in Ohio today announced that more than 250 physicians working with 75 practices in the Greater Cincinnati and Dayton regions have been selected to participate in a groundbreaking initiative to advance primary care and improve the accessibility and affordability of quality health care through a partnership with the Centers for Medicare & Medicaid Services (CMS).

CMS has selected 500 primary care practices in seven regions to participate in its Comprehensive Primary Care (CPC) initiative, a new partnership between payers including CMS, state Medicaid agencies, commercial health plans and self-insured businesses, and primary care providers. The partnership is designed to promote improved access to quality health care at lower costs. Anthem’s parent company is working with nearly 900 providers selected to participate in the partnership across its affiliated health plans in Colorado, Kentucky, Ohio and New York.

Through the CPC program, CMS will pay primary care practices a care management fee, initially set at an average of $20 per beneficiary per month, to support enhanced, coordinated services on behalf of Medicare fee-for-service beneficiaries. Simultaneously, participating commercial, state, and other federal insurance plans are also offering enhanced payment to primary care practices that are designed to support them in providing high-quality primary care on behalf of their members.

“We’re pleased that many Ohio physicians in the southwest region who work with us have been chosen for this pioneering initiative,” said Dr. Barry Malinowski, medical director for Anthem Blue Cross and Blue Shield in Ohio. “Anthem and CMS are aligned in our commitment to improve the accessibility and affordability of quality health care for all Americans, and we believe the CPC initiative represents a significant means by which we will achieve this. Anthem supports a patient-centered, primary care practitioner approach to health care delivery. For example, we’ve already seen successes in improving the quality of health care from earlier Ohio based pilot programs with the same patient-centered approach.”

For patients, the CPC initiative means participating physicians are encouraged to offer longer and more flexible hours; use electronic health records; coordinate care with patients’ other health care providers; better engage patients and caregivers in managing their own care; and provide individualized, enhanced care for patients living with multiple chronic diseases and higher needs.

“The Comprehensive Primary Care initiative is the kind of common-sense investment in health care we need,” said Health and Human Services Secretary Kathleen Sebelius. “Businesses, families, and taxpayers all benefit from a stronger primary care system that helps to improve our health and lower costs.”

The initiative started in the fall of 2011 with CMS soliciting a diverse pool of commercial health plans, state Medicaid agencies, and self-insured businesses to work alongside Medicare to support comprehensive primary care. Public and private health plans in Arkansas, Colorado, New Jersey, Oregon, New York’s Capital District-Hudson Valley region, Ohio and Kentucky’s Greater Cincinnati-Dayton region, and the Greater Tulsa region of Oklahoma signed letters of intent with CMS to participate in this initiative. The markets were selected in April, 2012 based on the percentage of the total population covered by payers who expressed interest in joining this partnership.

Eligible primary care practices in each market were invited to apply to participate and start delivering enhanced health care services in the fall of 2012. Through a competitive application process, primary care practices within the selected markets were chosen to participate in the Comprehensive Primary Care initiative. Practices were chosen based on their use of health information technology, ability to demonstrate recognition of advanced primary care delivery by leading clinical societies, service to patients covered by participating payers, participation in practice transformation and improvement activities, and diversity of geography, practice size, and ownership structure. CMS estimates that more than 300,000 Medicare beneficiaries will be served by over 2,000 providers through this initiative.

“Primary care practices play a vital role in our health care system and we are looking at ways to better support them in their efforts to coordinate care for their patients,” said Acting CMS Administrator Marilyn Tavenner.

The CPC initiative aligns and shares a foundation with Anthem’s patient-centered primary care initiative to significantly strengthen the role of primary care through added financial incentives and resources. Anthem announced its program earlier this year and has worked closely with CMS and others on the CPC effort.

The CPC initiative is a four-year initiative administered by the Center for Medicare and Medicaid Innovation (CMS Innovation Center). The CMS Innovation Center was created by the Affordable Care Act to test innovative payment and service delivery models that have the potential to reduce program expenditures while preserving or enhancing the quality of care.

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Anthem Blue Cross and Blue Shield is the trade name of Community Insurance Company, an independent licensee of the Blue Cross Blue Shield Association. ANTHEM is a registered trademark of Anthem Insurance Companies, Inc. The Blue Cross and Blue Shield names and symbols are registered marks of the Blue Cross and Blue Shield Association. Additional information about Anthem Blue Cross and Blue Shield in Ohio is available at . Also, follow us on Twitter at , on Facebook at , or visit our YouTube channel at .