Blue Quality Physician Program^℠

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:

• Increasing access to services
• Supporting care coordination across the continuum
• Improving patient accountability through information and active decision-making
• Driving efficiency and effectiveness

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:

• Family Practice
• Internal Medicine
• General Practice
• Pediatrics

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:

• Basic
• Intermediate
• Advanced

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.

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:

• Basic
• Intermediate
• Advanced

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.

1. 12-Month Rolling View. Allows practices to see where they are currently and how they've performed over the most recent 12 months. For example, if the report was run in March 2017, it would contain data from March 2016 through February 2017.
   
   
2. Prospective View. Shows care gaps based on current HEDIS measures for the calendar year, gaps currently open and how the practice is trending on closing that year's care gaps.

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.

• BQPP Quality Scorecard - Adult (xls)
• BQPP Quality Scorecard - Pediatrics (xls)
• BQPP Quality Scorecard - FMPeds Multispecialty (xls)
• BQPP Quality Scorecard - OBGYN (xls)
• BQPP Quality Scorecard - GYN (xls)
• Provider Quality Pocket Guide (pdf)

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:

• Step 1: Email Provider Engagement the date and time you would like to attend. Please write "Registration" in the subject line.
• Step 2: Once Pulse8 receives your request, you'll receive a WebEx invitation with login information for the session you requested.
• Step 3: When it's time to join the webinar, you won't need to create a WebEx account. Simply sign in as a guest with your name and email address.

Recorded Webinars:

• Step 1: Access the ACA Risk Adjustment Transaction through the Blue e portal under the Health Management tab at the top.
• Step 2: Use the education section to guide you to the webinars. Simply click the orange arrow to the left to access the webinars.
• Step 3: Click the title to the right of the video icon to access the webinar under Archived 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)

• Weight management and counseling - offering (or referring) intensive behavioral counseling intervention to adults who are overweight or obese, and have additional cardiovascular disease (CVD) risk factors, to promote a healthy diet and physical activity for CVD prevention Learn More (pdf)

• Online patient satisfaction survey - read, "Measuring Patient Satisfaction: How to Do It and Why to Bother" from the American Academy of Family Physicians (AAFP.org)
• Centering Group Visits (OBGYN only)
• Prenatal education classes (OBGYN only)
• Healthy Weight nutrition classes (OBGYN only)
• Well Child Group Visits (Pediatrics only)

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:

• Health Coach (RN, LPN, or MA)
• PharmD or Pharm Tech
• Social Worker (LCSW or LPC)
• Psychologist/Psychiatrist
• Nutritionist/Dietician
• RN-Triage
• Case Manager/Care Coordinator (MA, RN, LPN or CNA)

After hours and all below have to be listed on Practice website in order to receive points.

• After hours/weekdays (50 points)- after 5 pm or before 8 am on weekdays (total of 7 after hours weekdays)
• Weekdays and Weekend hours (both = 150 points) Total of 7 afterhours each
• Or 4 hours on weekends – 50 points
• and/or Co-management agreement with urgent care facility (must be 3 providers or less)- 50 points

• Telehealth (50 points) - may provide increased access to health care for patients and reduce the cost of patient care Learn More (pdf)

• - OR -

• Direct provider access afterhours (50 points) – offer a direct phone number to provider-on-call for urgent issues (doesn't include nurse line triage) Not Available for OB/GYN practices.

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:

• Asheville
• Charlotte
• Triad
• Triangle
• Eastern
• Wilmington

The member total cost calculation includes:

• Primary Care Office Visits
• Emergency Room Visits
• Inappropriate ER Visits
• Specialist Visits
• Urgent Care Visits
• Inpatient Hospital Admissions
• Imaging (MRI and CAT Scans)

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: