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Blue Cross Blue Shield of Massachusetts Awards Physicians $22 Million in Incentive Payments

This is the seventh consecutive year for payouts.

March 26, 2008 — Blue Cross Blue Shield of Massachusetts (BCBSMA) has paid physicians in Massachusetts an extra $22 million as a part of the 2006 Primary Care Physician (PCP) Incentive Program. This is the seventh consecutive year that physicians have earned incentive payments above their fee-for-service payments.

In addition, BCBSMA recognized 628 providers, with Certificates of Excellence. These physicians had results that placed them in the top 10% of physicians in our network.

The PCP Incentive Program is a quality-based program that BCBSMA launched in 2000 to reward physicians for providing important preventive health care and chronic care services as well as using important administrative technologies to improve quality of care. BCBSMA has paid PCPs more than $124 million in incentive payments since 2001. The program has been shown to improve quality of care. For example, the rate of Diabetic HbA1c measure (test to measure blood sugar control) was 85.4 percent in 2000 and improved to 92.7 percent at the end of 2006. The rate of well-teen visits was 56 percent in 2000 and improved to 72 percent at the end of 2006.

Ninety-six percent of PCPs earned an incentive under this program, with an average payment of approximately $6,670 per PCP. Physicians who used electronic technology or decision support aids in their practice received approximately $7 million in addition for doing so.

"For the last seven years, the PCP Incentive Program has recognized those physicians in our networks who provide exceptional health care to our members," said John Fallon, MD, Chief Physician Executive at BCBSMA. "We are fortunate to partner with physicians who are committed to delivering, and we are pleased to be able to recognize their efforts."

For adult practitioners, the services measured in 2006 were generic utilization; cardiovascular cholesterol screening; combination measure of diabetic care; and implementation of an electronic prescribing system, electronic medical records, or an office-based decision support system.

For pediatric practitioners, the measures were generic utilization; BMI screening; asthma management; and implementation of an electronic prescribing system, electronic medical records, or an office-based decision support system.

Each participating physician was measured on up to four different standards. Physicians receive half of their payments in July and the other half in December based on their efforts to provide preventive and chronic care services to BCBSMA members in 2006.

Aligning BCBSMA's quality program with the company's goal of achieving a higher quality of health care in Massachusetts, the program is evolving to measure quality screening based on outcomes as well as technology adoption, a change motivated by a continued effort to transform the current system from a pay-for-procedures to pay-for-results structure.

This aggressive campaign for a quality-driven transformation of the current health care system includes several changes to the company's current payment and incentive programs for providers and hospitals. In January, BCBSMA introduced an Alternative Quality Contract, a new payment system that pays providers a set figure per patient per year, adjusted for the health of each patient. Additionally providers will receive significant performance incentives, which are tied to the latest nationally-accepted measures of quality, effectiveness and patient experience of care.

BCBSMA has two other incentive programs. The Group Practice-based Incentive Program (GPIP) was launched in 2003 for groups of specialists. Group practices are measured in access, quality of care, and cost. BCBSMA closely collaborates with GPIP groups on their efforts to achieve results in these areas.

The second incentive program, the Hospital Performance Incentive Program (HPIP), was also launched in 2003 to reward hospitals that demonstrate a commitment to data-driven, outcome-oriented performance improvement. Last month, BCBSMA announced their decision to require hospitals to implement and utilize a Computerized Physician Order Entry (CPOE) program, based on the standards to be established by the MA CPOE Initiative, as a threshold for participating in their quality and incentive programs after 2012. In 2007, 64 hospitals earned a total of $104 million through the BCBSMA hospital performance incentive program.

 

Blue Cross Blue Shield of Massachusetts ( http://www.bluecrossma.com ) was founded more than 70 years ago by a group of community-minded business leaders. Today, headquartered in Boston, BCBSMA provides coverage to more than 3 million members, 2.5 million in Massachusetts. BCBSMA believes in rewarding doctors and hospitals for delivering safe and effective care, and in empowering patients to take more responsibility, become educated health care consumers and become stronger partners with their doctors. Blue Cross Blue Shield of Massachusetts is an independent licensee of the Blue Cross Blue Shield Association.

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