New Blue Cross VT Primary Care Provider Program
The enhanced Community Primary Care (ECPC) program is focused on providing monthly incentive payments for community primary care providers to support high-quality care while encouraging low-cost referral patterns for screenings and specialist care.
Berlin, Vermont — Blue Cross and Blue Shield of Vermont (Blue Cross VT) is working to transform health care in our state by taking manageable steps toward health care reform on behalf of members through a new community provider value-based program: Enhanced Community Primary Care (ECPC) payments.
“Blue Cross VT’s goal is to ensure that members have access to the highest quality care with the lowest possible premiums,” said Dr. Tom Weigel, Chief Medical Officer for Blue Cross VT. “At the same time, supporting our Vermont network of community-based providers and federally qualified health centers (FQHCs) is a priority. Our aim is to continue to make strong progress in transitioning our health care financing to support a sustainable health care system for all Vermonters.”
The ECPC program joins Blue Cross VT’s growing portfolio of value-based payment initiatives including the Vermont Blue Integrated Care (VBIC) pilot, which is now entering its second year. These efforts replace previous participation in the Accountable Care Organization’s (ACO) primary care support program.
Enhanced Community Primary Care
The goal of the ECPC program is to provide monthly incentive payments for community primary care providers to support high-quality care while encouraging low-cost referral patterns for screenings and specialist care. The ECPC payments are new in 2024 and will be dedicated to Vermont community-based independent primary care providers and FQHCs, regardless of whether they participated with the ACO in prior years or plan to do so in the future.
Blue Cross VT will supply participating providers with an annual score card that will compare them to their Vermont peers using both local and national population-based metrics, including engagement of substance use disorder treatment, cancer screenings, preventive well care visits, and immunizations; condition-based metrics, including control of chronic conditions; and total cost of care for their attributed patients. The intent is to incentivize high-quality cost-effective care, and support providers as they close the gaps in care through care coordination. Payments to providers will vary depending on the health complexity of their patients. Community primary care providers and FQHCs will begin receiving ECPC payments in February 2024.
Vermont Blue Integrated Care
Blue Cross VT’s advanced primary care model, Vermont Blue Integrated Care (VBIC), is a payer/provider learning collaborative entering its second pilot year. As in 2023, VBIC is comprised of four primary care practices, encompassing approximately 10,000 Vermonters. VBIC focuses on quality metrics for diabetes, hypertension, and cancer screening in addition to utilization metrics for emergency room visits and use of in-house or independent lab services. VBIC also offers an incentive payment to improve access to substance use disorder services, to increase collaborative care coordination, and to support innovative data sharing and reporting.
“The GMCB has challenged us to utilize reporting that supports providers to engage with their patients to improve outcomes while not adding administrative burden. These programs to support our community primary care practices aim to do just that,” said Dr. Weigel.
Blue Cross and Blue Shield of Vermont is a local, not-for-profit health plan. For over 40 years, the company has been enhancing the health and well-being of the Vermonters we serve by offering innovative plans to individuals, older Vermonters, and businesses. Our employees are dedicated to developing new ways to support high-quality care, programs, and events that promote wellness.
