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Fundamentally, BlueAlliance & BlueAlliance Care+ help health care organizations transition:
From: The current industry standard fragmented care model and fee-for-service payments
To: Coordinated, effective and quality care by implementing a patient-centered medical home model.
The higher the quality performance, the higher the monetary rewards.
The following measures are used for assessing quality of BlueAlliance & BlueAlliance Care+ providers. Based on provider feedback, the quality measures for BlueAlliance & BlueAlliance Care+ are aligned to the greatest extent possible.
Measure Name | 2023 | 2023 | 2023 | 2023 BlueAlliance |
Primary Care Visits (PCV) | Yes | Yes | Yes | Yes |
Post-Discharge Follow Up | Yes | Yes | Yes | Yes |
Potentially Preventable ER Visits (PPV) | Yes | Yes | Yes | Yes |
Potentially Preventable Admissions (PPA) | Yes | Yes | Yes | Yes |
Potentially Preventable Readmissions (PPR) | Yes | Yes | Yes | Yes |
Breast Cancer Screening (BCS) | Yes | Yes | Yes | Shadow |
Colorectal Cancer Screening (COL) | Yes | Yes | Yes | Shadow |
Cervical Cancer Screening (CCS) | Shadow | Shadow | Yes | Shadow |
Well Child Visits 0-15 Months (W30a) | No | Yes | Yes | No |
Well Child Visits 15-30 Months (W30b) | No | Yes | Yes | No |
Child and Adolescent Well-Care Visits (WCV) | Shadow | Shadow | Shadow | No |
For each provider model, there are minimum thresholds, target thresholds, and stretch goals, to incentivize better performance for higher pay.