Blue Cross Blue Shield of Mass. Rewards Docs for Efficient Quality of Care

HealthLeaders Media Staff, July 2, 2009

Many primary care physicians practicing under contract with Blue Cross Blue Shield of Massachusetts received a total of $27 million as a reward for meeting certain cost and quality goals in an annual incentive program that was among the first of its kind in the country when it began in 2000, the health plan said this week.

For all eight years of the award payouts, physicians have received a total of $164 million under the project, which is called the Primary Care Physician Incentive Program. The latest round covered achievements in 2007.

The recent payout, which was awarded to an undisclosed number of doctors, was a reward for high rates of ordering mammographies for their patients, appropriate management of diabetes and lipid levels, and for reporting outcomes from treatment of various chronic conditions.

Physicians who were more likely to receive the additional payment included those who routinely ordered body mass index tests for children, prescribed certain generic drugs instead of brand-named, and appropriately utilized laboratory testing services.

"The PCP Incentive Program is consistent with our work to transform the healthcare system to address the underuse, overuse, and misuse of healthcare services to award for the quality and outcome of care and of care our members receive," said John Fallon, MD, chief physician executive at BCBSMA.

BCBSM spokeswoman, Jenna McPhee, emphasized that, "Choosing which drug to prescribe is always at the discretion of the physician, and the targets for this measure were set to allow physicians to choose name-brands when they feel necessary."

The establishment of electronic medical record systems in doctors' practices also helped them achieve a qualifying score, as did completion of cultural competency training, said BCBSM.

Each year, the health plan releases a list of the incentives, and gives physicians a review after six months to illustrate how far they may be from their goals.

Blue Cross Blue Shield of Massachusetts representatives said that by giving doctors such incentives to incorporate these practices into their treatment settings, they have increased Healthcare Effectiveness Data and Information Set scores, a well-recognized way in which health plans and others measure the effectiveness of types of care.

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