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Value-Based Initiatives

Blue Cross and Blue Shield of Alabama has completed a comprehensive review of fee schedules and allowances to develop a broad provider payment and quality roadmap that encompasses physicians, hospitals and other healthcare professionals. The Primary Care Value-Based Payment (VBP) Program was launched in January 2011 for the following primary care specialties: geriatrics, family practice, internal medicine, general practice and pediatric medicine.

2015 Primary Care Value-Based Payment (VBP) Program Implementation Delayed

Blue Cross and Blue Shield of Alabama has elected to delay implementation of the 2015 Primary Care Value-Based Payment Program to allow time to re-evaluate thresholds, test recent enhancements, and make necessary changes to ensure the appropriateness of our measurement criteria for primary care specialties. We will continue to pay rewards under the 2014 Primary Care VBP Program structure until the 2015 VBP Program is implemented. In December 2014, only the Administrative category of the 2014 VBP Program will be rescored. As usual, you will receive a letter if your qualification status changes based on the rescore.

This delay will also give you time to view your most current performance criteria, which will be available in December 2014 through the Physician Performance Assessment (PPA) Tool, and to discuss any questions with your Provider Network Services Representative. Enhancements to the PPA include several Clinical Effectiveness measures that were not in prior releases, a 10-year look-back period for the colonoscopy quality metric, and the addition of immunization data from the Department of Public Health. We are also making an adjustment to the overall clinical effectiveness calculation, which may result in a variance from your previous PPA performance data.

Additional information on the 2015 VBP Program will be forthcoming and program materials will be updated once the thresholds are reviewed and certified. Look for an announcement through our email service to providers and on this Web page.

Primary Care

All Programs

For more information, contact your Provider Network Services Representative.