Medical Management serves under the direction of OPNS Chief Medical Officer, Imad Mansoor, MD and the OPNS Quality Assurance/Utilization Management Committee to support the continuous development of administrative quality improvement initiatives, the framework by which OPNS Network members receive quality services with an efficient use of resources. Medical Management promotes Population Health Management implementation in physician practices by providing quality performance reporting as well as educational resources and training for Health Plan Quality Improvement/Incentive programs including:

  • BCBSM Physician Group Incentive Program (PGIP)
  • BCBSM Patient Centered Medical Home/Neighborhood (PCMH-N) for both Primary Care and Specialty Care physician practices
  • BCBSM Primary Care and Specialist Value-Based Reimbursement (VBR)
  • BCBSM Organized System of Care (OSC)
  • Blue Care Network Commercial HMO Physician Recognition Programs
  • BCBSM/BCN Medicare Advantage Physician Recognition Programs
  • Priority Health Partners in Performance PCP Incentive program
  • Alternative Payment Models (APMs) i.e. Comprehensive Primary Care Plus (CPC+) and State Innovation Model (SIM)
  • Provider Delivered Care Management (PDCM) Medical Management supports physician practices in the transformation of healthcare delivery processes and promotes the Institute for Healthcare Improvement (IHI)“Triple Aim” Initiative.

Active engagement in Quality Improvement programs as well as the implementation of Healthcare Information Technology products supported by OPNS are critical to the continued success of OPNS and its member physicians.

 

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