—Contract designed to improve outcomes, reduce costs
—KMHP's first pay for performance agreement with a cardiology specialty care provider
PHILADELPHIA, Nov. 8, 2012 (GLOBE NEWSWIRE) -- Keystone Mercy Health Plan (KMHP), a member of the AmeriHealth Mercy Family of Companies (AMFC), and Cardiology Consultants of Philadelphia, P.C. (CCP) announced today that they have entered into a "pay for performance" agreement to promote quality care and outcomes and encourage efficient care. The contract is KMHP's first such agreement with a cardiology specialty care provider.
The agreement's performance metrics, and its incorporation of those metrics into a written contract with a specialist, is unique for Medicaid managed care plans in the region. KMHP's physician incentives to CCP will be determined by outcomes in multiple quality and efficiency metrics. KMHP will also provide CCP with actionable information in real-time to help it meet national benchmarks.
The quality metrics, all endorsed by the National Quality Forum, include ACE/ARB Therapy, Antiplatelet Therapy, Cholesterol/Lipid Testing, Beta Blocker Therapy, LVeF Assessment, LDL Lowering Therapy and Anticoagulant Therapy. These measures are designed to prevent heart attacks and complications from hypertension and coronary artery disease. The efficiency metrics point to effective management of potentially preventable readmissions and ambulatory care sensitive conditions, and are aligned with Medicare's national goals.
CCP is the largest cardiology group in KMHP's provider network and has been serving KMHP members for more than 20 years. It employs approximately 95 physicians and has offices in all five counties of KMHP's service area – Bucks, Chester, Delaware, Montgomery and Philadelphia.
This agreement is part of AMFC's PerformPlus(SM) program, which offers primary care physicians, specialists, hospitals and accountable care organizations a unique and comprehensive range of solutions for managing Medicaid populations. The program, which has already been implemented with KMHP's primary care physicians and hospitals, is an AMFC approach to provider contracting that aims to reward providers who improve outcomes and efficiency.
"By rewarding providers for better outcomes and efficiency, we help keep our members healthier and, as a result, out of the hospital and emergency room," said Andrea Gelzer, M.D., corporate chief medical officer for AMFC. "This unique partnership with CCP will greatly benefit our members with cardiovascular disease, CCP's physicians and strengthens Pennsylvania's HealthChoices Program."
Said Mark Victor, M.D., F.A.C.C., chief executive officer of CCP: "Cardiology Consultants of Philadelphia is pleased to become part of the KMHP pay for performance quality program. This new initiative provides a framework which both payers and physicians can work together to improve our patients' quality of care. These types of partnerships will be critical to ensuring that America's health care dollars are being used as effectively and efficiently as possible."
About Keystone Mercy Health Plan
Keystone Mercy Health Plan, a member of the AmeriHealth Mercy Family of Companies, is a Medicaid managed care health plan servicing over 321,000 members in five southeastern Pennsylvania counties. Headquartered in Philadelphia, Keystone Mercy Health Plan is a mission-driven company dedicated to helping members get care, stay well and build healthy communities. For more information, visit www.keystonemercy.com.
About AmeriHealth Mercy Family of Companies
AmeriHealth Mercy Family of Companies (AMFC) is one of the nation's leaders in health care solutions for the underserved. AMFC operates in 12 states and serves more than 4.5 million Medicaid, Medicare and CHIP members through its Medicaid managed care products, pharmaceutical benefit management services, behavioral health services and other administrative services. Headquartered in Philadelphia, AMFC is a mission-driven company with 30 years of experience serving low-income and chronically ill populations. For more information, visit www.amerihealthmercy.com.
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