Blue Cross and Blue Shield plans have dived headlong into pay-for-performance for physician services despite lingering questions about how best to design such programs and hesitation among doctors to embrace the trend.
According to a new survey, 29 of the nation's 51 Blues plans have launched a total of 37 pay-for-performance programs in 32 states, and 14 more Blues plans expect to roll out similar programs soon. These efforts ultimately could cover physicians treating 84 million patients in 46 states, according to the survey by Harvard Medical School researchers.
Only six Blues plans publicly report physicians' performance, but eight others said they planned to do so by 2006 or 2007.
Also last week, the American Medical Association, anticipating rapid growth of pay-for-performance programs among private payers and adoption by Medicare, released a long list of conditions for such efforts. Among the criteria: mandatory pilot-testing of programs before they're rolled out on a large scale. (See related story, p. 17.)
Allan Korn, chief medical officer at the Blue Cross and Blue Shield Association, which commissioned the survey, said the organization intends to collaborate with Harvard and the University of California at San Francisco to study incentive programs to assess what works.
"We do believe that the way to successfully impact quality and outcomes with integrity is to improve the level of medical care every physician in the United States is capable of providing," Korn said last week at a news conference.
Right now, universal physician participation seems far off. Among Blues-plan providers, 59% of primary-care physicians were eligible to take part in a pay-for-performance program, and 68% of those chose to do so. Among specialists, 34% were eligible to participate and just 48% of those opted to do so.
Many physicians report concerns about the validity and fairness of the measures used to judge their performance and discontent with payment methods (May 30, p. 6). Others say they are frustrated by the lack of standardization across programs.
All 37 incentive programs offered by the Blues plans gauged doctors on compliance with a variety of clinical guidelines. Twenty-two incorporated patient-satisfaction scores, 17 measured doctors' accessibility to patients and 15 scored physicians on their use of information technology. Many programs also used cost-related measures, such as pharmacy utilization, but the survey did not specify to what extent.