Doctor Pay May Change: Blue Cross Testing Rating-Based Pay

By Vicki Lee Parker, The News & Observer, Raleigh, N.C.

Apr. 7–Blue Cross has teamed with the N.C. State Health Plan to test a pay-for-performance system that rewards physicians who meet certain quality standards. The program will involve 70 practices across the state and nearly 600,000 state employees, teachers and retirees.

The company announced the three-year pilot program, which is part of a national health-care project called Bridges to Excellence, on Thursday at its annual Health Care Symposium for employer groups.

The Bridges to Excellence program was started a few years ago by large employers such as General Electric who wanted a systematic way to measure whether they were getting their money’s worth from health-care services. Such rating systems are gaining momentum, even though doctors have been lukewarm to them. United Healthcare, for instance, began its own physician grading system based on quality and efficiency in December. But the entry of Blue Cross, the state’s largest health insurer with 3.3 million members, into such a ratings system could affect the way patients are cared for in North Carolina. Blue Cross has said it could eventually use the program with all its members.

Doctors who participate could receive anywhere from $10,000 to $40,000 for meeting quality standards set by the National Committee of Quality Assurance, a nonprofit organization that helps develop standards and guidelines for the health care industry.

“We believe Bridges to Excellence will raise the quality of care for our members and State Health Plan members, as well as make a difference in the fight to reduce health costs,” said Bob Greczyn, president and chief executive of Blue Cross, in an statement.

Initially, the program will focus on primary care physicians, endocrinologists and cardiologists, and three areas of care: diabetes, heart and stroke, and physician office management, which includes patient education and support. The physicians will be graded based on nine standards including patient access and communication with doctors, care management, electronic prescribing, and test and patient tracking.

For instance, physicians would compile data on all patients who suffer from diabetes and track their treatments to see which patients are missing appointments or have failed to get specific tests.

The idea is that it costs less for tests and exams than to treat heart attacks and other complex problems that can occur when people wait too long to seek care.

“If we can make people feel better, we can lower our health costs and premiums and take those dollars to invest in other programs,” said George C. Stokes, executive administrator of the State Health Plan.

The N.C. State Health Plan and Blue Cross together plan to spend about $3 million in reward incentives.

A number of insurance companies and experts are welcoming the changes, saying that they will ultimately get patients better care.

“This is a movement to treating patients, rather than treating the symptoms and coding the system to maximize the reimbursement,” said John McDonnell, a principal with Progressive Benefit Solutions, a Raleigh consulting company. Under the old system, doctors were rewarded based on volume. Now the emphasis will be on how well the patient’s health improves, McDonnell said.

“We physicians are all for anything that will help patients become more healthy,” Dr. Conrad Flick, a partner in Family Medical Associates in Raleigh. “These incentive programs are a good way to do that.”

But these benefits will not come overnight, said McDonnell. Both doctors and consumers are going to have to undergo behavioral changes to meet the standards.

“They are not going to allow us to be obese and smoke,” McDonnell said. If consumers don’t change their habits, he said, the medical “cost is going to shift to those who neglect to take care of themselves.”

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