Blue Cross Blue Shield of Massachusetts Physician Incentive Programs Earn National Recognition.

Business Editors/Health/Medical Writers

BOSTON--(BUSINESS WIRE)--Jan. 26, 2004

The incentive programs developed by Blue Cross Blue Shield of Massachusetts (BCBSMA) to pay physicians more money based on their performance on specific quality measures was recognized today by the Blue Cross Blue Shield Association (BCBSA) and Harvard Medical School. BCBSMA also was lauded for its efforts to promote computer-based technologies.

"We are excited to be part of the Blue Cross Blue Shield Association's BlueWorks campaign, because we believe the program has the potential of making real and meaningful improvements in the nation's health care system," said Sharon Smith, BCBSMA Executive Vice President for Health Care Services.

In its evaluation of BCBSMA's incentive programs, Harvard Medical School Researchers found, "In addition to the strong commitment to improve quality through pay-for-performance as evidenced by the large financial commitment to this effort, this program also assists providers to deliver effective, evidence-based care. Patients who need to undergo specific services are identified and care-related education materials are made available to providers for distribution to targeted patients.

"The intention to reward providers who adopt computer-based technologies for care management and medication prescribing is particularly exciting considering the potential to improve the quality of care for all patients cared for by participating providers."

"This recognition gives us further validation of what we know to be an exceedingly successful and popular partnership with our PCPs ," said John Fallon, M.D., BCBSMA's Chief Physician Executive.

BCBSMA launched its PCP Incentive Program in 2000 to increase the number of BCBSMA members receiving important preventive and disease management services. The program gives PCPs the opportunity to earn additional reimbursement above the HMO fee schedule based on their performance on specific quality measures. The goals of this ongoing program are to ensure that members receive important preventive series, create performance-based reimbursement for PCPs and provide PCPs with actionable patient data to enable improvements.

In 2003, BCBSMA expanded its pay-for-performance initiatives to engage groups and specialists in quality improvement efforts through the Group Performance Incentive Program (GPIP). In this incentive program, the first in Massachusetts, specialists groups will be able to earn as much as 15 percent above otherwise contracted reimbursement for meeting criteria for quality, patient satisfaction and efficiency.

"BCBSMA's unique Group Practice Incentive Program simply makes sense. It effectively communicates the desired outcome, namely quality care and a satisfied patient. We would expect that this appropriate focus on quality and satisfaction yields lower health care cost for everyone," said Peter Kilmartin, a principal for the Mercer Human Resource Consulting.

The PCPIP program provides annual reports to physicians on five different measures, a list of patients yet to receive preventive care for those measures and payments based on performance. More than 3,300 PCPs and 700,000 plan members are included in this program.

Last year, BCBSMA paid physicians in Massachusetts approximately $16 million for their results in the 2002 Primary Care Physician (PCP) Incentive Program. More than 42 percent of all participating PCPs received the maximum payment for which they were eligible under the program. BCBSMA has paid PCPs $46 million in incentive payments since 2001.

Dr. Fallon said preliminary data from the GPIP program show that approximately half of the specialists groups in the program will receive the incentive payment.

During 2002, scores for PCPs who care for adults improved by 1.6 percent, while scores for PCPs who care for children improved by 3.8 percent. This means that more BCBSMA members are getting important preventive services.

For adult practitioners, the services measured are generic antibiotic utilization, mammography, Pap smear, asthma medication management and a combination of measurements involving diabetic care, including HbA1C levels and retinal evaluations. Another measure is LDL after a cardiac event. For pediatric practitioners, the measures are generic drug utilization, well visits for children (ages 2 years to 6 years), well visits for adolescents (ages 12 years to17 years), asthma medication management and substance abuse review.

Each participating physician is measured on up to five different measures, and is eligible for a bonus of $1 to $3 per HMO Blue member/per month.

Blue Cross Blue Shield of Massachusetts (www.bluecrossma.com) was founded 66 years ago by a group of community-minded business leaders. Today, headquartered in Boston, BCBSMA provides coverage to 2.4 million members. Consistently recognized for standards of service that are among the highest in the nation, Blue Cross Blue Shield of Massachusetts is the choice for health care consumers seeking reliable and high quality health care coverage. Blue Cross Blue Shield of Massachusetts is an independent licensee of the Blue Cross Blue Shield Association.