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New Care for Health Reimbursement Agreement Launched

Physician Connection

Winter 2013

 

In January 2013, RGHS and the Greater Rochester Independent Practice Association (GRIPA) launched Care for Health, an accountable care partnership with Excellus BlueCross BlueShield that supports the achievement of superior quality and medical performance that improves and sustains the health of our patients.

Under the Care for Health agreement, RGHS and GRIPA participating primary care physicians will be rewarded for providing superior quality and medical performance, according to 18 clinical Quality Measures reflecting accepted contemporary patient health and safety benchmarks (see below). RGHS’s longstanding documented record of providing high-quality care, coupled with an array of quality and safety initiatives that have been implemented within the health system over the past decade, will help ensure that these measures are met and surpassed.

 GRIPA is providing an infrastructure of resources for member physicians that will further support these ongoing efforts (see back cover for details). Additionally, the RGHS/GRIPA relationship – unique in the region – allows both private and employed primary care physicians to be included in this contract. This ensures greater consistency of care and improved outcomes for a wider patient base.

This innovative agreement is designed to assist RGHS and participating physicians in the delivery of high-quality, high-value care within the new health care reform landscape, as the traditional fee-for-service payment system transforms into a quality- and outcomes-based model. Care for Health leverages the shared commitment of RGHS, GRIPA and Excellus to provide exceptional and efficient care to the patients of the Rochester community.

The development of Care for Health, which began several years ago, anticipated the priorities of the Affordable Care Act in driving profound health care payment and delivery reform. It positions Rochester General Health System as the regional leader and national pioneer in that effort.

If you are a GRIPA member and would like to learn more about Care for Health’s benefits for your practice, contact Kelly Taddeo at 585.922.1543 or kelly.taddeo@rochestergeneral.org.

18 Quality Measures

  • Diabetes: HbA1c Test
  • Diabetes: HbA1c <= 9.0%
  • Diabetes: HbA1c < 8.0%
  • Diabetes: LDL Test
  • Diabetes: LDL < 100
  • Diabetes: Eye Test
  • Diabetes: Nephropathy Test
  • Diabetes: BP < 140/90
  • CAD: LDL Test
  • CAD: LDL < 100
  • CAD: BP < 140/90
  • Hypertension: BP < 140/90
  • Prevention: Colorectal Cancer Screening
  • Prevention: Breast Cancer Screening
  • Prevention: Osteoporosis Management
  • Plan of Care: Urinary Incontinence
  • Plan of Care: Falls
  • Patient Survey