Primary care physicians in Massachusetts will receive a total of $16 million from Blue Cross Blue Shield of Massachusetts for meeting disease management and preventive care benchmarks in 2002, say officials of the state's largest health insurer.
The physicians will receive half of the money this month and the remainder in December, officials add.
The payout is slightly below the $16.5 million participating physicians received last year, though performance scores actually improved in 2002, according to the Blues.
"We set the bar a bit higher," says Deb Devaux, vice president for provider contracts at Boston-based Massachusetts Blues. "We do want to make sure we are paying for the best possible care."
According to the Blues, quality-based incentive scores for primary care physicians who care for adults increased by 1.6% in 2002, while pediatricians improved their performance by 3.8%.
Blues officials could not immediately provide the number of participating physicians, but Devaux says more than 90% of primary care physicians who participated in the program will receive some sort of bonus payment. At least 42% will receive the maximum bonus of $3 per patient per month, Devaux says.
"It does end up being potentially 15% of the physician's salary, depending on the panel size," Devaux says.
Physicians are eligible for an extra $1 to $3 per month per patient for meeting specific care goals for the 1 million Massachusetts residents enrolled in the HMO Blue plan. Massachusetts Blues covers a total of 2.4 million people in all its health plans.
Adult practitioners may earn bonuses for preventive and diagnostic measures such as recommending first-generation generic antibiotics, mammography, Pap smear, asthma medication management and other screening specific to diabetics and cardiac patients. Pediatricians are judged on generic antibiotic utilization, well visits for children and adolescents, asthma medication management and substance abuse review.
This year, for the first time, primary care physicians also are being measured on patient satisfaction and access to care, Devaux says. She adds that the Blues reviews claims to help physicians identify patients for intervention.
"We send (physicians) the information they need to be successful," she says. "We give the doctors the data they need to be successful."
Massachusetts Blues says physicians now have earned $47 million in quality incentive bonuses since the first payments began in 2001. The program was among the first pay-for-quality efforts in the nation.