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Keystone First, Cardiology Consultants of Philadelphia Expand Successful Value-Based Collaboration

New agreement is product’s first based on episodic payment; Original program reduced inpatient admissions and low acuity emergency room utilization since 2012.

Keystone First, a Blue Cross Medical Assistance (Medicaid) product and the largest Medical Assistance product in southeastern Pennsylvania, announced that it is expanding its successful value-based relationship with Cardiology Consultants of Philadelphia (CCP). The new agreement will be based on an episodic payment model.

“Entering this type of agreement requires a very strong relationship with a great deal of trust. And that describes our relationship with CCP,” said Keystone First Market President Joanne McFall. “CCP was one of the first providers to sign a value-based contract with us, and now it is the first provider to sign one based on episodic payments. We greatly appreciate CCP for all it has done for our members, and we are excited to join them in this next step in our relationship and in helping to transform health care.”

Since 2012, CCP has used the cardiology incentive program that is part of Keystone First’s PerformPlus® suite of value-based contracting programs. Since then, Keystone First members under CCP’s care have experienced per member, per year reductions in rates of inpatient admissions and low acuity emergency room utilization, or emergency room visits requiring less intensive care. Keystone First members served by CCP have also improved their compliance rates in 7 of the program’s 9 measures.

“The physicians and staff of Cardiology Consultants of Philadelphia (CCP) are excited to take this historic step in our relationship with Keystone First,” said Mark F. Victor, MD, FACC, chief executive officer of Cardiology Consultants of Philadelphia. “CCP and Keystone First have enjoyed a long and successful collaboration of working toward innovative relationships to enhance both the quality of care through guideline driven metrics and the efficiency of that care in an effort to control costs. This new contract furthers CCP’s mission is to enhance the quality of care for patients in the Greater Philadelphia region.”

The new agreement builds on those successes. At the end of each year, Keystone First will compare CCP’s performance (based on claims paid) on the following procedures to their peers and their own historical trends:

  • CABG, valve repair, and other complex heart surgeries
  • Pacemaker and defibrillator installation and use
  • Acute heart attacks
  • Arrhythmia
  • Coronary artery disease
  • Heart failure
  • Hypertension

If costs (as measured by claims paid) decrease under the program, CCP will receive a share of those savings based on its performance on quality and efficiency measures.

About Keystone First
Keystone First is a Blue Cross Medical Assistance (Medicaid) managed care health product offered by Vista Health Plan, Inc., an affiliate of Independence Blue Cross, in five southeastern Pennsylvania counties. Here at Keystone First, we are mission-driven and dedicated to helping members get care, stay well and build healthy communities.

Independence Blue Cross and Vista Health Plan, Inc. are independent licensees of the Blue Cross and Blue Shield Association.