Blue Cross Blue Shield of Massachusetts Rewards Physicians 27 Million Details

BCBSMA was kind enough to provide details on the program. The incentive program is one of the most generous I've seen to date. SV

PCPIP Background:

1.) The PCP Incentive Program was among the first of its kind in the nation. It was introduced in 2000 in order to:
· Collaborate with our Providers to improve systems and processes that prevent medical errors and improve quality of care
· Support our Providers with data that assists them in practicing more effective and efficient care
· Increase the amount of provider reimbursement that is linked to incentives (Quality/Safety, Technology Adoption, Satisfaction, Reporting/Transparency)
· Evolve the payment methodology over time so that providers are paid differently for providing safe, effective and efficient care.

2.) Measures used in 2007 fall in three categories:
· Quality Outcomes, which includes such measures as mammography, diabetes management, and reporting outcomes for chronic conditions (for practitioners who care for adults), and well visits, BMI tracking (for practitioners who care for children)
· Efficiency, which looks at generic prescribing and laboratory utilization
· Electronic Technology, which measures use of electronic medical records and e-prescribing.

3.) Through the PCP Incentive program, we have shown increased HEDIS rates (the Industry standard for measuring health plan performance) on targeted measures, enhanced technology adoption (making Massachusetts the top e-prescribing state nationwide for the last 3 years), and providing funding that has enabled PCPs to make additional investments in their practices.

4.) The PCP incentive program is run on a calendar year; each year there are a number of measures with a potential incentive amount, expressed as a per member per month figure. PCPs receive reports mid-year to let them know how they are doing and to provide data so that they can improve their performance on relevant measures. Once the performance year ends, we calculate their results on each measure and provide them with an end-of-year report that communicates the per member per month amount they earned. They receive their payments in two halves, with the final payment being in December of the year FOLLOWING the performance period based. The results are being publicly announced now.

5.) In 2007, all PCP Incentive Program participants were eligible to earn incentives of $4.00 per member per month (PMPM). Providers whose results fall in the top 10% of all PCP Incentive Program participants were eligible to earn an additional $1.00 PMPM, enabling top performing providers to earn up to $5.00 PMPM. These physicians were also recognized through our Excellence in Primary Care award program.

6.) There were 3,194 PCP participants that received payments:
- 752 Pediatricians
- 741 Family Practioners
- 1701 Internal Medicine

7.) 636 PCPs were recognized with Excellence in Primary Care certificates