Monday, September 22, 2014
Inquirer Daily News

Blue Cross to pump an extra $47 million a year into primary care

Independence Blue Cross, the region's largest health insurer, plans to boost payments to primary care doctors by $47 million a year directed toward practices that improve quality and meet certain efficiency goals. The goal is to encourage primary care doctors to deliver higher quality and more efficient care by rewarding them with incentives for achieving certain goals.

Blue Cross to pump an extra $47 million a year into primary care

I. Steven Udvarhelyi, executive vice president of health services at Independence Blue Cross
I. Steven Udvarhelyi, executive vice president of health services at Independence Blue Cross

Independence Blue Cross, the region's largest health insurer, plans to boost payments to primary care doctors by $47 million a year directed toward practices that improve quality and meet certain efficiency goals. The goal is to encourage primary care doctors to deliver higher quality and more efficient care by rewarding them with incentives for achieving certain goals.

Blue Cross also believes that by rewarding primary care doctors through incentives for delivering better care, it will save money by keeping patients healthier and out of hospitals.

At the same time rewarding good care at that level, Blue Cross hopes to encourage new doctors to pursue careers in primary care.

“Two of the most pressing issues beyond access to care which health reform legislation enacted in Washington has addressed, are a crisis in health care costs and significant issues still with the quality of care provided,” said I. Steven Udvarhelyi, executive vice president of health services at Blue Cross.

The insurer will spend $33 million of the additional money to double its incentive pay for doctors who meet certain quality standards and those who achieve certification as patient centered medical homes. The rest of the money will be used to reward doctors for providing efficient, cost effective care.

The quality incentive payment system will reward doctors who meet benchmarks for certain nationally recognized standards such as having diabetic patients get blood sugar testing, cholesterol screening, as well as regular foot and eye exams.

The efficiency incentives rewards doctors for ensuring patient care is delivered in cost effective ways such as prescribing generic drugs rather than expensive brand named medications that are essentially the same. Similarly, doctors who arm patients with x-rays or other scan results when sending them to see a specialist can help prevent duplication of those imaging tests without detracting from the quality of care the patient gets.

“We are doing this because we do need ... to create the right foundation for real reform in the way care is delivered,” Udvarhelyi said.

The program covers Blue Cross HMO members including those in Keystone Health Plan East and Keystone 65 – its Medicare HMO program.

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Michael R. Cohen, R.Ph. President, Institute for Safe Medication Practices
Daniel R. Hoffman, Ph.D. President, Pharmaceutical Business Research Associates
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