This new Quality Blue program (Quality Blue PT/OT) is part of a series of programs Blue Cross and Blue Shield of Louisiana has created in partnership with care providers in the network that drive value by improving patients’ health and lowering costs.
“We are pleased that Blue Cross approached us and wanted our input toward creating a program that would reward therapy providers for getting better results for their patients,” said Virginia Davis, PT, President of PTPN of Louisiana and Mississippi. “PTPN providers nationwide have been measuring patient treatment outcomes since 2007, so we were eager to participate. Through Quality Blue PT/OT, we have a new way to see how we measure up against national trends, which helps us to continually improve our services.”
Blue Cross worked with therapists around the state to develop Quality Blue PT/OT, examining how to effectively boost patients’ health outcomes and satisfaction with their therapy experiences.
“Blue Cross is a leader in teaming up with providers to determine the best ways to drive quality while saving on total costs of care,” said David Carmouche, M.D., Blue Cross Executive Vice President for External Operations and Chief Medical Officer. “In the past year, we successfully launched our Quality Blue Primary Care program for population health, but we wanted to expand this focus to other, specialty types of care. With the Quality Blue PT/OT program, we are using an innovative approach to create value for a treatment that many of our members use.”
The program uses the Focus On Therapeutic Outcomes, or FOTO, tool to measure an enrolled therapy practice’s patient functional outcomes and benchmark these results against patient treatment outcomes nationally. The tool lets a practice compare the amount their patients improved during therapy treatment, and how long the treatment took, with data for similar patients around the country. Enrolled therapists are reimbursed for services on an enhanced fee schedule, to reward them for taking the extra steps to measure their progress with FOTO and implement best practices to improve patients’ experiences. Quality Blue PT/OT began in October 2013, with PTPN and another provider partner, Baton Rouge Physical Therapy–Lake.
PTPN has been using FOTO as the engine of its mandatory outcomes measurement system, the PTPN Outcomes Program, since 2007. PTPN of Louisiana and Mississippi was the network’s first region to mandate outcomes measurement as part of a pilot program launched in 2005; PTPN launched the program in all regions two years later. The Blue Cross Quality Blue program is the latest in a series of innovative partnerships PTPN has established with health plans to drive value by rewarding superior outcomes.
“We recognize that the healthcare industry is replacing ‘pay-for-performance’
“Anticipating these changes, PTPN began measuring actual treatment outcomes for our therapy offices seven years ago. The PTPN Outcomes Program assesses our therapists’ outcomes data and spotlights providers who deliver the most value — those that achieve the best patient outcomes most cost-effectively,”
Quality Blue PT/OT is open to any Blue Cross Network physical or occupational therapists who are currently using FOTO or are willing to use this or a similar tool that lets them effectively measure outcomes and benchmark them against national data. Providers may access FOTO by becoming PTPN members; contact firstname.lastname@example.org for more information. Interested providers may also contact their Blue Cross Network Development representative or email network.administration@
PTPN is the nation’s premier specialty network of rehabilitation therapists in independent practice. It has led the rehabilitation industry in pioneering national contracting and quality assurance programs since 1985. The network has nearly 1,000 provider offices (including physical, occupational and speech therapists) in 23 states. PTPN contracts with most major managed care organizations in the nation, including insurers, workers’ compensation companies, PPOs, HMOs, medical groups and IPAs. All members of PTPN must be independent practitioners who own their own practices. For more information on PTPN, contact Stephen Moore at 818-737-0246 or email@example.com, or visit ptpn.com.
About Blue Cross and Blue Shield of Louisiana:
Founded in New Orleans in 1934, Blue Cross and Blue Shield of Louisiana is a private, fully-taxed mutual company, owned by policyholders — not shareholders. It is an independent licensee of the Blue Cross and Blue Shield Association and is governed by a Louisiana Board of Directors. The company and its subsidiaries provide group and individual health insurance plans, life and disability insurance, group voluntary products and administrative services to Louisiana residents. With headquarters in Baton Rouge and eight district offices around the state, Blue Cross and Blue Shield of Louisiana is committed to improving the lives of its customers by providing them with health guidance and affordable access to quality care. Learn more on the company’s website at www.bcbsla.com or visit its social media hub to connect via Facebook, Twitter and more.
The Blue Cross and Blue Shield Association is a national federation of 37 independent, community-based and locally-operated Blue Cross and Blue Shield companies that collectively provide healthcare coverage for nearly 100 million members — one in three Americans. For more information on the Blue Cross and Blue Shield Association and its member companies, please visit bcbs.com. We encourage you to connect with us on Facebook, check out our videos on YouTube, follow us on Twitter and check out The BCBS Blog, for up-to-date information about BCBSA.