Video: Higher quality care, fewer doctor visits under innovative provider payment system

Published December 19, 2019

Changing the way doctors are paid is improving patient care and decreasing doctor visits under an innovative pilot that emphasizes quality over quantity at Blue Cross and Blue Shield of Hawaii (BCBS Hawaii) also known as Hawaii Medical Service Association (HMSA). That’s according to a study published by the Journal of the American Medical Association (JAMA).

The pilot program

HMSA partnered with 107 primary care providers in 2016 to launch a pilot that would enable doctors to prioritize patients based on who needs the most care.

The program is called Population-based Payments for Primary care (3PC). The payment model operates under a single monthly payment for every HMSA patient in the doctor’s practice. This replaces the traditional fee-for-service model which puts an emphasis on quantity over quality. 3PC payments are adjusted to reflect the needs of the sickest patients. The payment system also compensates providers when they engage patients with preventive measures like screenings.

Results of the study

The July 2019 JAMA published study on the 3PC program noted the following:

  • The results of the 3PC pilot program show an 11.5% increase in the quality of patient care and preventive services with no additional health care costs.
  • There have also been notable increases in the percentage of patients receiving colorectal cancer screenings, mammograms, immunizations, and diabetic eye exams.
  • HMSA notes that several physician organizations have been able to control growth of healthcare expenditures to a rate that’s very close to consumer inflation – much less than what usually happens with medical costs.

Watch this video to see how doctors reflect on the patient transformation following the implementation of value-based payments.

Hawaii Medical Service Association is an independent licensee of the Blue Cross Blue Shield Association, an association of independent, locally operated Blue Cross and Blue Shield companies.