BCBS of Massachusetts Expands Pay-for-Performance Program

Blue Cross Blue Shield of Massachusetts is doubling to $189 million the annual amount it spends on performance incentives for health care providers, the Boston Globe reports. The initiative, which is effective for this year, puts Blue Cross Blue Shield "at the forefront" of insurers' efforts around the country to transition from a reimbursement system based on automatic payments to a pay-for-performance system, the Globe reports.

BCBSM said reimbursements to 5,200 primary care physicians delivered in the form of incentives will increase from 10% of its total payouts to as much as 13%. As a result, an individual primary care doctor could receive more than $10,000 based on performance measures.

Performance measures for primary care doctors will include the number of patients who receive cholesterol screenings, pap smears or mammograms, and the number of diabetic patients whose blood sugar is carefully monitored. In addition, BCBSM is developing ways to measure the performance of 9,100 cardiologists, oncologists and other specialists in Massachusetts so that between 5% and 10% of their reimbursements are based on performance.

Because there is "little agreement" about appropriate performance measures for specialists, BCBSM plans at first to measure only how well doctors adopt programs to reduce medical errors, the Globe reports. In addition, BCBSM will devote as much as 2% of its total reimbursements to 60 hospitals to incentive-based pay, up from 29 hospitals last year.

Hospitals will be graded on patient satisfaction surveys and on five measures that hospitals choose from a list of 14. The company also said it is considering replacing automatic inflation adjustments with performance incentives (Rowland, Boston Globe, 5/10).