Anthem Blue Cross and Blue Shield in Ohio and affiliated health plans in 13 other states became the first health plans Tuesday to reward providers that receive Integrated Care Certification from the Joint Commission.
The insurer said the certification would count toward its care coordination measure under Anthem's Quality-In-Sights: Hospital Incentive Program (PDF), its performance-based reimbursement program for hospitals. The program aims to improve patient outcomes by offering financial incentives for hospitals that use evidence-based medicine and deploy best practices.
The decision affects about 800 hospitals and 38 million people, said Joyzelle Davis, a spokesperson for Anthem. To date, none of those hospitals have actually received the Integrated Care Certification, but "Anthem's willingness to recognize the ICC will hopefully encourage more hospitals to pursue the certification," Davis said.
According to the Joint Commission, only one hospital, Parrish Medical Center, in Florida, has received the certification, although "several hospitals and ambulatory practices have expressed interest," said Elizabeth Eaken Zhani, a spokesperson for the Joint Commission. So far, Anthem plans are the only ones to include the Integrated Care Certification in a provider incentive program.
Recognizing the Joint Commission's certification as a standard for the Hospital Incentive Program would help “reduc[e] the administrative burden of meeting those standards,” Anthem Blue Cross and Blue Shield President Erin Hoeflinger said in a statement.
The Joint Commission's Integrated Care Certification, begun in July 2015, recognizes hospitals and ambulatory care centers that excel at sharing information and integrating other forms of communication in the handoff between inpatient and outpatient settings. In the concept of integrated care, patient care is seamlessly coordinated across a continuum, no matter what kind of treatment the patient receives or where.
Anthem's decision fits into a larger nationwide push to pay for healthcare on the basis of quality over quantity. Healthcare providers and insurers alike are taking aim at making care more efficient, more coordinated, and more focused on the patient.
Government payers are seeking to drive change with various value-based payment models, with the CMS marching forward with demonstration projects for bundled payments and accountable care organizations. Commercial payers are similarly shifting more risk to providers and creating incentives for higher value care.
In January 2015, for instance, a group of influential healthcare providers, insurers and employers formed a task force aimed at putting 75% of their business by 2020 into payment models that reward for better outcomes, quality and cost management.
This broader shift is driving insurers, providers and other organizations to develop new metrics and programs to assess and reward improvement in the value of care, such as the Integrated Care Certification.
That certification is voluntary, and whether a hospital or outpatient center receives Integrated Care Certification does not affect their overall accreditation status.