Pilot Program Yields Success for BCBSOK Primary Care Providers

“We believe the formula for the success of the Greater Tulsa Region CPC initiative is the collaboration among the payers, the engagement from the field service teams and the commitment of our participating providers to work together to support practice transformation which is improving health outcomes for our members,” said Joseph R. Cunningham, M.D., Divisional Senior Vice President of Health Care Delivery and Chief Medical Officer at BCBSOK. “We are pleased to have joined forces with CMS and other payers on this project and it is rewarding to see the positive impact the CPC initiative is having on the overall health of our state. Together, we are making a difference in Oklahoma.”

Have you heard? According to the U.S. Department of Health and Human Services’ Centers for Medicare & Medicaid Services (CMS), the Greater Tulsa Region was the only participant, out of seven total, to have savings after the second year of the CMS Innovation Center’s Comprehensive Primary Care Initiative (CPC). The CPC initiative offers payback to primary care physicians over the course of four years, if they meet or beat specific milestones.

 In January 2016, BCBSOK medical directors (picture to the left), Dr. Steve Swyden (middle left) and Dr. Peter Aran (middle), along with Victoria Curtis-Ragland (middle right), RN, a BCBSOK Clinical Practice Liaison, presented the primary care physicians at Stillwater Medical Center a shared savings check for collaborating with BCBSOK and achieving patient successes in year two (2014) of the CMS Innovation Center’s Comprehensive Primary Care Initiative pilot program. Oklahoma was the only state out of seven total regions that attained net savings in year two. 

In 2013, Blue Cross and Blue Shield of Oklahoma (BCBSOK), the largest private payer in the state, teamed up with CMS and other payers to offer Oklahoma-based primary care practices a chance to participate in the CPC initiative. This four-year, multi-payer test program challenges primary care physicians to transform their practices, improving the health of their population, along with, better health care and lower medical costs, all of which leads to improved health in Oklahoma. The program focuses on reimbursing providers for the outcomes achieved for their patients. There were 64 practices selected by CMS to participate, encompassing 265 providers in the Greater Tulsa Region, which served approximately 140,000 Oklahomans.

This unique program is truly a partnership between participating payers. One key to the success of the Greater Tulsa Region is the addition of MyHealth Access Network, whose technology allows providers to have wider access to the health history of the patients they are actively treating. MyHealth Access Network was chosen by CMS to be one of the three data gatherers across the nation and is also part of a bigger picture in change to outcomes- based medicine which serves as a health information exchange in Oklahoma.

Motivations for the primary care practices, including the opportunity to receive shared savings payments when valuable data is achieved, became available the second year after the program was born. According to the CMS report, the Greater Tulsa Region made a net savings of $10.8 million. Of the 64 Oklahoma clinics participating, 49 achieved the quality control standards needed to move on to the next year of the program.

The success of the CPC pilot program in Tulsa is now being copied with other BCBSOK primary care doctors across Oklahoma. BCBSOK will continue to work on these relationship to achieve long-term savings and improve health and wellness outcomes for our members.

For more information, check out the The Centers for Medicare and Medicaid website.

This dowloadable list of physicians includes those who are participating in the Greater Tulsa Region Comprehensive Primary Care initiative. Help us to congratulate their success in reaching positive results for BCBSOK members through the Comprehensive Primary Care initiative! Does your doctor help you reach your goals? Let us know in the comments!