Dear [Customer],

Value-based provider incentive payments included in May self-funded invoices
QIPS for PPO members is IBX's Blue Distinction Total Care program

Since we shared the latest BDTC story in Independence Edge earlier this month, there have been some questions about billing for self-funded customers. To help clarify some of the information causing confusion, we are reissuing the Independence Edge story we first sent you in early April, to better explain the impact to invoices, related to QIPS for PPO members.

As part of our ongoing commitment to value-based care, Independence Blue Cross is working alongside other Blue plans nationwide to transform health care delivery through value-based payment programs. This overall national program is called Blue Distinction Total Care (BDTC), and Independence's BDTC program is the Quality Incentive Payment System (QIPS). QIPS, first introduced for HMO members in 1992, has been updated to include our PPO members, and you will begin to see the value-based program payments on your invoice next month.

Why value-based care? How does it improve the member's experience?
Independence and Blue plans across the country are strong proponents of primary care as the foundation of an optimal health care system. For that reason, PPO QIPS was designed around the idea of primary care doctors managing the overall health of their patients. Through PPO QIPS and all other national, BDTC pay-for-performance programs, providers have the opportunity to earn bonus payments for delivering the highest-quality, most efficient care to our members. Independence's local value-based program is the PPO QIPS program; all providers who participate in PPO QIPS are part of the national BDTC program.

How am I billed for the BDTC program?
Beginning in May, invoices for your self-funded benefit programs will include an attribution component for PPO members who are attributed* to PPO QIPS doctors. A per attributed member per month (PaMPM) component of $2.49 will appear on the May 4 invoice that you will receive and will include this PPO QIPS component for members attributed in January, February, and March 2016. The multi-month billing is a one-time occurrence; beginning with June invoices, the PPO QIPS/BDTC component will be included in the 'Paid Claims/Expense' line on invoices.

What do we mean by 'Attribution' or 'Attributed Members'?
PPO members are counted or assigned (attributed) to primary care offices using a review of member claims history. Through this attribution process, doctors know which members they are responsible for and this becomes the foundation for clinical coordination incentives to providers. Attribution is based on where a member lives, the provider they see, and when they see the provider.

• PPO members who reside in the PA-9 county area* are eligible for attribution to a PPO QIPS provider.
• Claims data is analyzed to determine the primary care physician that an eligible member has seen most frequently in the most recent 18-month period.
• Independence members who reside outside the PA-9 county area* are eligible for attribution to the value-based program in the area in which they reside.