BCBS of AL Primary Care Select Program

2017 BCBS of AL Primary Care Select Program

Qualifications for the value-based initiatives for the BCBS Primary Care Select Program will be based on two performance measures:

  • Patient Focus (10%)
  • Clinical Effectiveness (20%)

The maximum reward possible is 30%.


To become a Select provider to participate, providers must:

  • Meet all requirements in the Primary Care Select Program as outlined in the Primary Care Select Program Participation Criteria document.
  • Be a PMD provider for a minimum of one consecutive year and be in good standing.
  • Participate in all applicable Blue Cross and Blue Shield networks. The current applicable network for the Primary Care Select Program is Blue Advantage® (excluding pediatricians).
  • Adult primary care physicians must be eligible to participate in the Blue Advantage Primary Care incentive Program by meeting the program’s minimum Clinical Effectiveness threshold.

***Please note, this information is subject to change. For the most current information, view program materials on the Blue Cross website, AlabamaBlue.com/providers, by choosing “Select Programs” under Provider Resources.

 

Patient Focus (10%)

Combined overall score of 70 must be met to qualify for this category.

NCQA® Patient-Centered Medical Home:

  • PCMH Level 3 – 75 points
  • PCMH Level 2 – 60 points
  • PCMH Level 1 – 45 points

NCQA® Diabetes Recognition Program – 45 points

Patient Satisfaction: Measure is based on the overall satisfaction question in survey on AlabamaBlue.com, in the Patient Satisfaction tab of Doctor Finder.

  • 3-star rating – 25 points

Active E-Prescriber – 25 points

Clinical Effectiveness (20%)

Adult Primary Care Physicians: Within the Physician Performance Assessment (PPA) Tool, your overall Clinical Effectiveness must be 70 or greater to achieve this measure.

Pediatricians: Within the Physician Performance Assessment (PPA) Tool, your overall Clinical Effectiveness must be 85 or greater to achieve this measure.

Your star should appear at or above the set threshold in the Effectiveness and Efficiency Performance Matrix on the Physician Scorecard tab to qualify for this category.

 

 

These thresholds are subject to change. If you have questions, please refer to the BCBS FAQs located here: https://www.bcbsal.org/providers/Select/

Or, contact your Provider Network Consultant at 1-866-904-4130 (toll free).

Unlike any other vendor, MediSYS includes unique connectivity to BCBS of Alabama which allows login-free, web access in seconds with no duplicate data entry.  This connectivity is embedded within MediSYS PM so clinics can quickly verify E&B, obtain Patient Health Snapshot, check Rx History, Claim Status, Medical Records and more!