Blue Cross and Blue Shield of North Carolina (BCBSNC) is leading an effort to reward health care quality in North Carolina by introducing a new reimbursement model for participating primary care physicians.
BCBSNC, the state’s largest health insurer, is offering substantially higher payments to physicians who take steps to further improve the quality of patient care they provide. Under its Blue Quality Physician Program, about 4,000 primary care physicians across the state have been invited to apply for the higher reimbursement structure. The program is designed to reward quality over quantity in the delivery of medical services.
“For too long our health care system has been built on paying for the volume of procedures rather than the quality of outcomes,” said Don Bradley, M.D., BCBSNC senior vice president and chief medical officer. “Blue Quality Physician Program is our way of getting incentives where they belong – with quality outcomes, not volume.”
The program is open to North Carolina primary care physicians – family and general practitioners, internists, pediatricians, obstetricians and gynecologists – who agree to BCBSNC’s standard contract for in-network physicians.
Participating physicians who meet a set of criteria that includes nationally recognized, evidence-based standards for quality of care are eligible for reimbursement that offers double-digit increases over BCBSNC’s standard fee schedule for some of their most commonly billed codes. BCBSNC will reimburse at a higher level once the physician is approved for the program.
“Physicians understand the need to measure quality and improve efficiency, but often don’t have the resources to upgrade their office infrastructure and evaluate results,” said Joseph Ponzi, M.D., with Goldsboro Pediatrics, a practice with multiple offices in Eastern North Carolina. “Programs like these are a great incentive to investing in improving patient care, developing the ‘medical home’ concept and meeting higher quality standards, while becoming eligible for higher reimbursement.”
BCBSNC introduces Blue Quality Physician Program on the heels of its successful Bridges to Excellence quality improvement program. That three-year pilot program, which concluded in April 2009, brought the nationally recognized Bridges to Excellence program to North Carolina, offering incentive payments to physicians meeting national standards.
Following the Bridges to Excellence pilot, BCBSNC determined that providing incentives for meeting quality standards had a payoff in terms of higher quality measures and lower health care spending per patient. For example, patients of physicians who met Bridges to Excellence quality standards for efficiencies in practice management received fewer high-cost imaging tests such as CT scans and didn’t visit the emergency department as often.
“Health care is embracing quality and efficiency standards, which also offer promise for improving the affordability of health care,” said Milo Brunick, BCBSNC vice president of Network Management. “Blue Cross and Blue Shield of North Carolina looks forward to collaborating even more with physicians, hospitals and other health care providers to improve cost and quality for patients.”
Participating physicians in Blue Quality Physician Program earn higher reimbursement by achieving standards in three categories:
- Clinical quality outcomes, which includes recognitions by the National Committee for Quality Assurance, use of electronic prescribing and other quality-related standards
- Administrative efficiency, including electronic claims submission
- Patient experience with care, which measures the physician’s ability to provide such patient-centered needs as after-hours care and electronic visits
BCBSNC will review physicians’ applications and assign scores based on the number of quality criteria met. Any physicians not meeting minimum scores may re-apply.
Blue Cross and Blue Shield of North Carolina is a leader in delivering innovative health care products, services and information to more than 3.7 million members, including approximately 900,000 served on behalf of other Blue Plans. For 76 years, the company has served its customers by offering health insurance at a competitive price and has served the people of North Carolina through support of community organizations, programs and events that promote good health. Blue Cross and Blue Shield of North Carolina is an independent licensee of the Blue Cross and Blue Shield Association. Access BCBSNC online at www.bcbsnc.com.