The Colorado Business Group on Health (CBGH) is a not-for-profit organization that is changing the way employers buy health care, with a focus on education, networking and programs based on best practice in high-value health care and benefit design. Members understand that the interests of employers—both as individual organizations and as community members—align most naturally with primary care professionals in communities and several of CBGH’s programs are aimed at strengthening this alliance.
Since 2007, a number of employers have paid awards to physicians who attain diabetes or cardiac recognition in the Bridges to Excellence (BTE) program. In the past three years, coalition members have paid more than $160,000 to these physicians. Another program, in Colorado Springs, has employers working directly with the major primary care practices (PCPs) in their town in order to achieve two related goals: reduce the amount of dollars spent on potentially avoidable complications, and increase enrollee selection and use of primary care physicians. Recognizing that to achieve these goals, the employers, enrollees and physician practices all needed to change certain behaviors, these employers and the engaged physicians negotiated a model of “mutual accountabilities.”
Employers commit to implementing a value-based benefit design (two or three tier) with significant financial incentive to use PCPs. Additionally, they agree to financially support administration of the Prometheus model and share savings on total cost of care (TCOC) with physicians. Enrollees commit to actively participate in managing and improving their health by selecting a PCP and maintaining compliance with care plans. Physician practices agree to participate in either the BTE or Patient-Centered Medical Home program within the first year as well as providing accessible, evidenced-based primary care for participating enrollees. In addition, practices will report biometric data. The program is being phased in during a two-year period beginning with the 2016 plan year.