Enhanced Personal Health Care Program - New York

Program Location: 
Albany, NY
Payer Type: 
Empire Blue Cross

Reported Outcomes


The new Enhanced Personal Health Care Program includes an Empire-specific Patient-Centered Primary Care Program, as well as the. This program builds off of a previous WellPoint PCMH pilot (reported outcomes for that pilot were published in a 2012 Health Affairs article) WellPoint's New York patient-centered medical home is a single health plan model. It pays doctors an “enhanced” fee pegged to the achievement of quality levels. The program originated, in part, from the New York City Department of Health’s Primary Care Information Project. In that project, the department began placing electronic health record systems in selected primary care physician offices in 2008. The goal was to improve care in underserved communities through health information technology.

Initially, to be eligible, physicians had to have a 30 percent Medicaid patient volume; this threshold was later reduced to 10 percent. To participate, practices had to commit to following patient-centered principles of care. Under the project, the department agreed to pay the software licensing fees for eligible practices, provide on-site training and tools, and help practices obtain National Committee for Quality Assurance recognition.

Related News & Resources

Fewer ED / Hospital Visits: 
  • 11% fewer ED visits for adults; 17% for children
  •  7.8% fewer inpatient admissions per 1000*

  • 5.7% fewer inpatient days per 1000*

  • 7.4% decrease in acute admissions for high-risk patients with chronic conditions*

  • 3.5% decrease in ER costs and 1.6% reduction in ER utilization*

Improved Health: 
  • Lower rates of inappropriate antibiotic use (27.5% v. 35.4% p<.001)
Cost Savings: 
  • 14.5% lower PMPM costs for adults; 8.6% lower for children
  • 5.1% PaMPM decrease in outpatient surgery costs*

Increased Preventive Services: 
  • 5% increase in HbA1c testing
  • Results showed an increase of 22.9 per 1,000 PCP visits for high-risk patients.*

Other Outcomes: 

*Based on overall program analysis, not New York-specific

Last updated March 2019
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