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Blue Cross Blue Shield Of Massachusetts To Expand 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. Reaction
BCBSM Executive Vice President Andrew Dreyfus said, "The best, most promising route to slowing the rate of [health premium] increase is by investing in quality and performance." However, James Roosevelt, CEO of Blue Cross Blue Shield competitor Tufts Health Plan, said a "better way" to change the payment system would be for Massachusetts insurers to agree on uniform performance standards. Alan Harvey, president of the Massachusetts Medical Society, said insurers should not use performance measurements until a nationwide standard has been agreed upon (Rowland, Boston Globe, 5/10). Pill-Splitting
In other insurance news, the South Florida Sun-Sentinel on Wednesday examined how UnitedHealthcare since late 2005 has provided 50% discounts on drug copayments to beneficiaries who split pills in half. The offer applies to 16 drugs that come in easy-to-split tablets. UnitedHealthcare Pharmaceutical Solutions CEO Tim Heady said 13 million people with employer-sponsored health plans are eligible for the program, which can provide discounts of up to $300 a year. About 11% of eligible beneficiaries participated in the pill-splitting program in its first few months, and Heady said the percentage should increase to about 30%. Pill-splitting could save UnitedHealthcare about 1% of its $8 billion in annual drug costs, and about one-third of the savings would be returned to beneficiaries, the Sun-Sentinel reports (LaMendola, South Florida Sun-Sentinel, 5/10).

"Reprinted with permission from http://www.kaisernetwork.org. You can view the entire Kaiser Daily Health Policy Report, search the archives, or sign up for email delivery at http://www.kaisernetwork.org/dailyreports/healthpolicy. The Kaiser Daily Health Policy Report is published for kaisernetwork.org, a free service of The Henry J. Kaiser Family Foundation . © 2005 Advisory Board Company and Kaiser Family Foundation. All rights reserved.





Blue Cross Blue Shield din Massachusetts pentru expandare Plata-pentru-Program de performanþã - Blue Cross Blue Shield Of Massachusetts To Expand Pay-for-Performance Program - articole medicale engleza - startsanatate