Premera Blue Cross Global Outcomes Contracting

Program Location: 
Mountlake Terrace, WA
Payer Type: 
Partner Organizations: 
Everett Clinic
The Polyclinic
Family Care Network
Franciscan Medical Group
Northwest Physicians Network
Pacific Medical Centers
Pediatric Associates
Puget Sound Family Physicians
Rockwood Clinic
Wenatchee Valley Medical Center
Premera Blue Cross

Across Washington state 12 major physician groups and an independent physician association, who combined manage care for nearly 100,000 Premera members, have joined the Global Outcomes Contracting model to help control costs while improving quality of care for patients. Through Premera's new payment model, groups are being rewarded annually based on a combination of the cost savings they demonstrate and the quality of care they provide to their patients' total health over the course of the preceding year. Initial results indicate this new approach is beginning to help moderate rising medical costs, as the first groups who are participating in Premera's new payment model are seeing results. For example, the total healthcare cost trends last year for Premera patients managed by the Everett Clinic and the Polyclinic were 3-5 percent below the average of other Premera patients in the same region who have a regular physician, after accounting for differences in health. The Medical Home program at Everett Clinic focuses on having each patient partner with a team of healthcare providers to develop a comprehensive, personal health care plan for their patients. 

Payment Model: 

Premera’s new payment model takes it a step further by examining the total cost of the patient and also incorporating an important quality component. This ensures that costs are contained without a reduction in the quality of care for patients. In addition, the physician groups participating in this initiative are implementing new strategies to improve quality and control healthcare costs.

Last updated February 2015
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