Pay-for-Performance Programs Reward Physicians, Promote Computer-Based Technologies
Blue Cross and Blue Shield of Massachusetts
Blue Cross and Blue Shield of Massachusetts (BCBSMA) sought to improve the quality of preventative services when it developed a Primary Care Physician (PCP) Incentive Program in 2000. 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 services, create performance-based reimbursement opportunities for PCPs and provide PCPs with actionable patient data to enable improvements.
Program Elements
- Provides annual reports to physicians on five different measures, a list of patients yet to receive preventative care for those measures, educational tools and payments based on performance.
- In 2003, BCBSMA expanded its pay-for-performance initiative to engage groups and specialists in quality improvement efforts through the Group Performance Incentive Program.
- More than 3,300 PCPs and 700,000 Plan members are included in this program. BCBSMA will leverage the programs' resources in 2004 to encourage physicians to invest in and use electronic technologies for disease management, decision support and electronic prescribing. The Plan expects this to have far-reaching effects in the delivery of quality care to their members and all the citizens of Massachusetts.
Program Results
- PCP Incentive Program has provided physicians with more than $45 million in incentive payments and contributed to documented improvements in selected HEDIS (Health Plan Employer Data and Information Set) scores, which are expected to yield cost savings.
- Along with performance-based incentives, the program partners with the physician by delivering preventive and disease management services and actionable patient data.
Contact
Steven J. Fox, Provider Relations and Communication, 617-246-5647, steven.fox@bcbsma.com
