Program excellus

Getting started is easy! Simply participate in one these programs, pay for services and submit a reimbursement form and receipt. Earn one visit credit by completing a fitness center visit and get rewarded once you reach 50 visits each 6-month reward period. Tracking your fitness center visits is easy — with one of the following or a combination of both:. Skip to Main Content Area. The CareSight program is available 24 hours a day, 7 days a week.

If a member is selected for the CareSight program, PopHealthCare will reach out to the member directly. Excellus BCBS and PopHealth Care work together to help the member understand and manage his or her health to prevent unnecessary trips to the emergency room and even unnecessary hospitalizations. We are dedicated to having our members live healthy lives. Submit a complaint about your Medicare plan at www. These programs support providers in their efforts to improve patient safety outcomes while improving fiscal performance through means other than increases in payment rates.

The PPI consultants provide additional ad hoc support to hospital quality teams and physician practices through: 1 targeted and focused interventions as opportunities are identified; and 2 accreditation and regulatory program activities.

Accountable Cost and Quality Agreements ACQA are innovative payment programs designed to drive improvements in patient experience, cost trends, and quality of care. Similar to an Accountable Care Organization ACO , the programs establish a new relationship between the health plan and partner integrated healthcare systems or large primary care physician groups based on healthcare quality and financial gain share.

ACQA, administered with the integrated healthcare systems, is a full innovative payment program with both upside and downside risk. Savings generated by exceeding the budget target is shared with the system based on overall quality performance. Should financial performance result in a loss, the proportion of the loss passed to the system is moderated by the overall quality performance score.

The RPE Program is a performance improvement incentive program for primary care physicians. This program is designed to introduce practices to both quality and cost improvements through a focus on both high quality and efficiency performance. The program also serves as a foundational step in a hierarchical portfolio of innovative payment programs, and is set up as a foundation for seamless transition into more robust ACQA arrangements.

This pay-for-performance program is rolled out as hospital contracts open for negotiation. The menu-driven incentive program utilizes all payer data, rather than just our own, for measurement and applies it to all lines of business contracted with the hospital.

The program exists best as a componenet of multi-year agreements and models a prospective payment methodology. Annual performance targets using nationally recognized measures are established to define expectations for improved performance, and if the hospital achieves the target outcomes agreed upon jointly, the negotiated extra payment for quality applies the following year.

These measures specify how organizations collect, audit and report performance information across the most pressing clinical areas, as well as dimensions of patient satisfaction and experience. HEDIS is updated annually and consists of five domains of care.