Albany Doctors Deliver High-Quality Care and Cost Savings for Blue Cross and Blue Shield of Georgia Members



Albany Doctors Deliver High-Quality Care and Cost Savings for Blue Cross and Blue Shield of Georgia Members with New Value-Based Payment Arrangements

Statewide Results Show Improvements in Quality, Cost Savings

ALBANY, Ga., (June 2, 2016) By participating in a program sponsored by Blue Cross and Blue Shield of Georgia (BCBSGa), primary care doctors practicing in Albany have been among the most successful in the state at delivering high-quality care and lower costs.

Enhanced Personal Health Care (EPHC) was launched in Georgia in July 2013, and more than 1,200 physicians across the state currently participate in the program. These doctors care for more than 200,000 BCBSGa members.

In recognition of their results in delivering efficient, high-quality care, participating BCBSGa providers received $21.5 million in shared savings. In many cases, practices reinvest the shared savings by hiring care coordinators or purchasing electronic health records to assist with population health management.

Locally, Albany doctors had exemplary results, including these improvement rates for delivering evidence-based care:

  • Since February 2015, Shaw Center has maintained 100% compliance with delivering recommended cervical cancer screenings.
  • From September 2014 through February 2016, there has been a 22% improvement in the rate of annual eye exams for patients with diabetes who are treated at the McIntosh Clinic.
  • From September 2015 to February 2016, Brian Griner, MD maintained 100% compliance prescribing the most effective asthma medications for his patients.
  • Between September 2014 and February 2016, at Southwest Georgia Healthcare, there has been a 19% increase in testing diabetic patients’ HbA1c levels.
  • Since beginning participation in July 2014, primary care providers at Albany Internal Medicine have seen an 18% overall drop in their patients’ ER visits and a 32% decrease in the rate of potentially avoidable emergency room visits.
  • The Veranda has seen a marked drop in the same measure since July 2014, lowering the rate of potentially avoidable ER visits by 28%.

BCBSGa members who see a physician participating in the EPHC program reported many benefits, including better access to urgent care, better communication with providers and higher satisfaction with the amount of time they spent with their doctors.

Enhanced Personal Health Care is the centerpiece of BCBSGa’s collaboration strategy, known as BCBSGa Togetherworks℠. Enhanced Personal Health Care is built on the belief that the primary care-patient relationship is the most important part of promoting health and wellness. The program’s goal is to strengthen that bond while rewarding primary care physicians for emphasizing quality and value in everyday practice.

“The increased collaboration between primary care physicians and specialists has made a tremendous impact on our members who are looking for quality and affordability. The physicians who participate in the EPHC program have made a huge impact on their patients’ health,” said Jeff Fusile, president of BCBSGa. “We found that our members who see EPHC physicians require fewer follow-up visits since health challenges are treated proactively.”

The BCBSGa Enhanced Personal Health Care team is equipped with many tools to share, arming providers with information and insights they need to manage population health and deliver patient-centered care. Resources include member data that enables providers to target members with chronic conditions or gaps in care — like prescriptions that have not been filled or missed medical testing, as well as a system to flag members at risk for readmission to the hospital.

Statewide in 2014, participating Georgia primary care physicians had 1.7% higher rates of delivering recommended care for diabetic patients, a 3.5% better rate of delivering evidence-based adult preventive services, and 4.4% better performance on ensuring patients took their medications as prescribed.

More than 40,000 PCPs are participating in the program across the country, caring for 4.7 million members of BCBSGa and its affiliated plans.

To earn shared savings bonus payments, practices must meet quality performance goals, which include quality standards established by organizations such as the National Committee on Quality Assurance, the American Diabetes Association, the American Academy of Pediatrics and others. Primary care physicians who maintain or improve quality may earn up to 35 percent of any cost savings that have been obtained over the last year.

About Blue Cross and Blue Shield of Georgia: Blue Cross and Blue Shield of Georgia, Inc. and Blue Cross Blue Shield Healthcare Plan of Georgia, Inc. are independent licensees of the Blue Cross Blue Shield Association. The Blue Cross Blue Shield names and symbols are registered marks of the Blue Cross and Blue Shield Association. Additional information about Blue Cross and Blue Shield of Georgia, Inc. is available at