Blue Cross Partners with Evergreen Family Health for Integrated Primary Care

JANUARY 26, 2022

Berlin, Vermont — Blue Cross and Blue Shield of Vermont and Evergreen Family Health are partnering to provide collaborative primary care programs. This arrangement allows for additional integrative primary care monitoring and care management that are anticipated to result in higher levels of success for Blue Cross members who are Evergreen patients. In recognition of Evergreen Family Health’s commitment to excellent care and reform collaboration, the practice is the inaugural recipient of the Blue Cross Provider Innovation Award.

This partnership tests the keystone of health reform, pairing shared risk and a per member per month care management payment with measurable patient quality outcomes. Together we will track four meaningful areas of patient health: uncontrolled diabetes; hypertension; FIT testing for colorectal screening; and risk adjustment coding.

“This endeavor aligns with what we are trying to accomplish in primary care for our patients. It has been a rewarding experience to think outside of the box and have Blue Cross support our joint priority focusing on quality measures which actually improve patient health outcomes ” says Dr. Michael Johnson, Managing Partner for Evergreen Family Health.

“Our goal is to empower and support independent primary care practices. Evergreen has approached this work collaboratively and with a patient-centered attitude,” says Lou McLaren, Director of Provider Services at Blue Cross. “We have come together to address core quality outcomes with equal risk on both sides, while supporting the practice’s care management function. These three pieces are the core tenets of health reform.”

The quality measures were carefully chosen to reflect patient health improvements and cost reduction. In each, the goal is to make it as simple as possible for both the patient and the provider to reach success. These are concerning areas in health care where we can do better to manage chronic conditions and common concerns.

For example, for individuals with uncontrolled diabetes, Blue Cross will support the practice in purchasing continuous glucose monitors for patients who are poorly managing their blood-sugar levels. These are people who are not yet insulin-dependent but are actively managing their nutrition. With this intervention, the patient can see in real time how their body and blood sugar respond to a double cheese pizza with pepperoni. Often, seeing is believing. The monitor, along with nutritional counselling can help them to make dietary changes that they can see and feel. The goal for the practice is to achieve a 1 point drop in A1C blood test results—which can mean the difference between the patient being a controlled versus an uncontrolled diabetic.

The concept behind the hypertension quality measure is similar. A reliable at home blood pressure cuff allows patients to take readings at home. This helps the patient and their providers to monitor blood pressure readings in the real world rather than just getting a snapshot during an office visit. This information allows for a more individualized treatment plan by adapting dietary changes, lifestyle interventions, and medication regimens.

The fecal immunochemical test (FIT) is an alternative to a colonoscopy. The FIT test offers a less invasive, lower risk, and lower cost alternative to a surgical intervention. Because of its ease and convenience, FIT testing has much higher compliance among all populations. The test can be done annually at home, for individuals who are at average risk for colon cancer. The American Cancer Society recommends colorectal screenings begin for individuals over 45. If the FIT test returns a positive result, the provider would recommend a colonoscopy.

As the fourth quality measure, the risk adjustment process provides Blue Cross with additional data to identify patients with chronic conditions and for their provider to develop care management programs and prevention initiatives to better serve them.

“We are working every day to ensure our patients have the best possible care. Care management is a key component for reaching quality outcomes for our patients,” said Pam Farnham, RN, and Clinical Nurse Manager for Evergreen Family Health.

Blue Cross intends to expand this program to additional primary care practices statewide in 2022.

“Our goal is to move away from laborious administrative burdens to meaningful benchmarks,” said McLaren.

The program that was developed between Blue Cross and Evergreen is serving as a springboard to support other primary care practices in our network and to ensure the best possible care for our members.