April 15, 2014

Blue Cross and Blue Shield of Louisiana Drives Value with Innovative Physical, Occupational Therapy Program

BATON ROUGE, La. – Blue Cross and Blue Shield of Louisiana’s newest Quality Blue program helps physical and occupational therapists identify best practices and promote high-value healthcare for patients.

The Quality Blue Physical & Occupational Therapy Program (Quality Blue PT/OT) is part of a series of programs Blue Cross has created in partnership with care providers in the network that drive value by improving patients’ health and lowering costs.

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 outcomes and benchmark these results against national outcomes. 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.

"Focus on Therapeutic Outcomes, Inc. has been developing outcome measurement tools and risk-adjusted benchmark reporting since 1994. These reports are used by FOTO customers to measure patient response to care, manage the clinical process to be more efficient and effective and report their results to patients, referral sources and payers. More recently payers, like Blue Cross, have seen the value of using FOTO outcome data to develop a new payment paradigm that rewards providers on results,” said Al Amato, MBA, PT, President of FOTO, Inc. “This allows the payer to move from paying for services without any ability to determine the benefit to the patients to one that allows for treatment based on need and payment based on results. This value-based payment approach is innovative in how the payment requires provider accountability that is rewarded with an incentive bonus. The triple aim of healthcare reform is to be patient-focused, improve healthcare and improve efficiency. Blue Cross should be commended in taking the lead in creating an incentive program that aligns the provider and payer in promoting this triple aim.”

Quality Blue PT/OT began in October 2013, with Baton Rouge Physical Therapy – Lake and Physical Therapy Provider Network (PTPN), a network of outpatient rehabilitation clinics located throughout Louisiana, as the first enrolled providers. 

“Baton Rouge Physical Therapy – Lake has a 50-year history of providing exceptional care. Our belief is that in order to provide the highest quality of care, we have to use evidenced-based practice patterns and techniques supported by measurement of our patient’s functional outcomes,” said Seth Kaplan, PT, President and CEO of BRPT-Lake. “We have utilized FOTO since 1994 to measure our results against local and national benchmarks. FOTO has enabled us to work with Blue Cross to develop the Quality Blue PT/OT program with the common goal of measuring functional outcomes and rewarding providers for achieving higher-than-expected outcomes in fewer-than-expected visits. This innovative program will benefit patients and physicians by helping them identify Quality Blue PT/OT participating providers.”

“We were pleased 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. “Our providers have been measuring 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.”

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. Interested providers should contact their Network Development representative or email network.administration@bcbsla.com for more information.

For more information about the Quality Blue programs, visit http://www.bcbsla.com/Providers/Pages/QualityBlue.aspx.

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.

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