Blue Quality Physician Program℠
Incentivizing independent primary care practices to improve quality and lower the cost of care.
New for 2017! Please Review the new Adult Criteria, Pediatric Criteria, Multi-Specialty Criteria and OB/GYN Criteria
Incentivizing independent primary care practices to improve quality and lower the cost of care.
The BQPP focuses on Primary Care Management and rewards independent practices committed to providing high-quality outcomes, and low-cost, patient-centered care for BCBSNC members.
How are members attributed to a practice?
Attribution to BCBSNC Members is based on the following criteria and is used for cost and quality:
Members are attributed to the primary care practice they have visited the most (based on Evaluate & Manage claims). If there is a tie, then attribution is based on most recent visit. If there is no primary care utilization during the study period, then the attribution is to OB/GYN practice. Members without any (primary care or OB/GYN) utilization during the study period are not included, as there are no relevant claims on which to attribute those members to a provider.
We offer qualifying independent primary care practices (not affiliated with large health care systems and academic health centers) an opportunity to participate in the BQPP program to improve quality of care for BCBSNC members.
What primary care practices can apply?
Independent primary care practices that meet BQPP criteria are eligible to receive a double-digit fee increase on their Evaluation and Management (E&M) and Preventive E&M codes. Please see Specialty Criteria, links below for details on scoring.
Practices that enter the BQPP will receive:
New & Renewing BQPP Practices:
Practices can apply twice a year: March 1 - April 30 or August 1 - September 30
Learn more about applying for credentialing or email your questions about credentialing, provider numbers, contracts and sample fee schedules to network management at: NMSpecialist@bcbsnc.com.
Mandatory - Practices must have earned one of these types of recognition (All locations must be recognized):
All recognitions are valued at 225 points (we no longer have different points for levels)
Patient Centered Medical Home
Primary Care and OB/GYN practices can apply for URAC PCMH.
URAC's PCMH (Primary Care Medical Home) certification is made up of standards that align with the "Joint Principles of the Patient Centered Medical Home" issued jointly by the four leading national primary care medical societies. URAC's Achievement program delivers on the promises of health care reform by:
URAC's PCMH program uses a unique approach with an unprecedented level of flexibility and customizable elements in a stepwise approach not available in other medical home programs. On-site review allows for an interactive and consultative approach to the review process. The program provides both strong educational support and cost advantages.
Visit URAC online, or email or call Sheila Brunson at 202-326-3964 for more information. There is a discount for BQPP practices applying for URAC PCMH.
Primary Care and OB/GYN practices may apply for The Joint Commission PCMH Certification.
Primary Care Medical Home (PCMH) Certification for Joint Commission Accredited ambulatory care organizations focuses on care coordination, access to care, and how effectively a primary care provider and interdisciplinary team work in partnership with the patient (and where applicable, their family).
The PCMH certification option is consistent with the new federal health care reform efforts to improve health outcomes and the continuity, quality and efficiency of health care services.
To find out more about JCAHO PCMH Certification please visit www.jointcommission.org .
NCQA PCMH is appropriate for the following primary care medical practices:
Mid-level practitioners may achieve PCMH recognition.
PCMH recognizes clinician practices functioning as medical homes by using systematic, patient-centered and coordinated care management processes.
The patient-centered medical home is a way of organizing primary care that emphasizes care coordination and communication to transform primary care into "what patients want it to be." Medical homes can lead to higher quality and lower costs, and can improve patients’ and providers’ experience of care.
There are three levels of NCQA PCMH recognition:
If your practice has multiple sites, all sites must be PCMH recognized.
NCQA offers a 20% discount to practices that are sponsored when they apply to receive their NCQA Recognitions. BCBSNC is considered your sponsor. Please enter the NCQA code "CNCBCA" on your NCQA application to receive the discount. Visit www.ncqa.org for more information.
Visit www.communitycarenc.org for NCQA PCMH cheat sheets and tools to assist you through the process.OB/GYN Practices
All locations must be PCSP recognized.
NCQA PCSP recognizes specialty practices that have successfully coordinated care with their primary care colleagues and each other, and meet the goals of providing timely access to care and continuous quality improvement.
Practices that become recognized will demonstrate patient-centered care and clinical quality through: streamlined referral processes and care coordination with referring clinicians, timely patient and caregiver-focused care management, and continuous clinical quality improvement.
There are three levels of NCQA PCSP recognition:
To participate in the BQPP, your practice must be recognized in PCSP. If your practice has multiple sites, all sites must be PCSP recognized.
NCQA offers a 20% discount to practices that are sponsored by BCBSNC when they apply to receive their NCQA Recognitions. Please enter the NCQA code "CNCBCA" on your NCQA application to receive the discount. Visit www.ncqa.org for more information.
SCOPE helps OB/GYN assess the implementation and use of patient safety concepts and techniques and distinguishes those offices with strong patient-safety practices. Education and assistance is provided when office processes requiring improvement are identified.
SCOPE focuses solely on processes associated with enhancing the safety environment and reducing risk for patients in the office setting. SCOPE does not evaluate the quality of clinical care provided by an OB/GYN office. Visit Scope for Women's Health online to learn more.
Provider Quality Report
The PQR report must be pulled monthly from Blue e. We encourage practices to utilize these reports to close care gaps.
These practice-based reports use claims data to give our doctors and provider groups' member-specific care gap information and an analysis of their performance against nationally recognized measures.
All primary care practices that were continuously contracted with BCBSNC during the measurement period will receive these reports, including Internal Medicine, Family Practice, Pediatrics, OB/GYN practices, and any multi-specialty practices that include any of the above specialties.
We encourage practices to use these Provider Quality Reports to close care gaps. For questions concerning PQRs, contact Quality Management by email or call (919) 765-4809.
Measuring and monitoring quality data is an important part of population health management. BCBSNC will provide practices with an Excel spreadsheet to fill out with numerators and denominators for the following measures, by practice type.
Please pull one year look back or as close as your EMR allows. This is for all populations. To complete your submission, fill in the spreadsheet(s) and email to bqpp@bcbsnc.com after submitting your application.
BCBSNC has partnered with Pulse8 to provide educational resources related to risk adjustment factor coding, also known as HCC coding.
All providers are required to watch at least two recorded or live webinars prior to applying for BQPP. To verify, practices will attest on the BQPP application.
Review the 2017 calendar of available webinars in pdf or recorded.
Live Webinars:
Recorded Webinars:
Patient portal (mandatory requirement) - a secure website that gives patients convenient, 24-hour access to personal health information from anywhere with an Internet connection. Using a secure username and password, patients can see health information such as recent doctor visits.
Online appointment requests - patients can request an appointment through the secured portal to create ease of scheduling
Group visits - learn about shared medical appointment guidelines (pdf)
Practice website and/or co-management agreement with behavioral health provider:
Advanced care team members must be engaged with BCBSNC members to receive points.
25 points
If the practice does not employ one of the provider types listed below, 25 points will be allocated. If the practice partners with a behavioral health provider through a co-management agreement to provide mental health/substance abuse treatment and care coordination for the patients of the practice, practices will attest to having a behavioral health provider co-management agreement on the BQPP application.
50-75 points
The BQPP values practices that utilize an advanced care team model. The program will assign points if your practice employs one (50 points) or more (75 points) of the following types of providers on a part-time or full-time basis:
After hours and all below have to be listed on Practice website in order to receive points.
Telehealth (50 points) - may provide increased access to health care for patients and reduce the cost of patient care Learn More (pdf)
- OR -
The Practice Cost Report (Internal BCBSNC Data) is an evaluation of the cost efficiency and utilization metrics of a practice in comparison to peer-group practices by specialty and region in North Carolina.
Regions:
The member total cost calculation includes:
Practice cost report cost index goal: .93 or below
BCBSNC generates the practice cost report at the time a practice applies to the BQPP program to determine the number of points the practice will be awarded.
The report is shared with the practice after the application is scored. If a practice's cost index is higher than 1.17 it will be placed on a cost improvement plan for one year.
The cost index is the practice data divided by the peer practice data. Points are awarded based on the practice's cost index as follows:
Cost Index | Points | ||||
---|---|---|---|---|---|
.93 or below | 400 | ||||
.94-1.01 | 325 | ||||
1.02-1.09 | 275 | ||||
1.10-1.17 | 125 | ||||
1.18-1.30 | 75 |
BQPP Practice Collaborative:
The BQPP program team will facilitate quarterly online "Best Practice Sharing Forums." The forums will provide an opportunity for BQPP practices to share the lessons they’ve learned and the tools they have used in their journey to healthcare transformation. The goal is to create a collaborative environment for the BQPP practices to learn from one another.
Primary Care Research and Trends:
Throughout the year, BQPP practices will receive articles and research focused on key trends, changes and challenges that primary care providers and their practices currently face, along with resources on how to overcome barriers. We'll also offer select educational webinars from state and national health care organizations.
Continuing Medical Education Courses:
The following courses are optional for practice staff and providers to view (these are not included in the BQPP criteria or points).
Every practice must have at least 30 BCBSNC members. To complete your application, you'll need the following:
Blue Cross and Blue Shield of North Carolina does not discriminate on the basis of race, color, national origin, sex, age or disability in its health programs and activities. Learn more about our non-discrimination policy and no-cost services available to you.
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