Blue Cross of MA expands pay-per-performance system to PPO markets
The spotlight in local health care news this week shines on Blue Cross Blue Shield of Massachusetts and its continued efforts toward performance-based payment reform for doctors. This system that pays doctors based on how well they care for patients will expand to include more than one million members. For patients, this should mean a decrease in office visits and unnecessary testing, and an increase in individualized health management and post-procedural care.
Currently, a fee-for-service system accounts for 66 percent of the Massachusetts market. Specialists agree, this traditional practice – one where doctors are paid per patient visit, needle prick and procedure – encourages unnecessary testing and overbooking appointments, often under prioritizing patient health.
BCBSMA members with HMOs have been offered a quality-based plan called the Alternative Quality Contract since 2009. Studies have shown the AQC, which now serves 680 thousand members, has proven to decrease costs and improve patient care. The new initiative is designed for the PPO market, which gives members more flexibility when choosing doctors or hospitals. Doctors and hospitals that adopt the new plan will be given a set budget to care for patients, then subsequently rewarded or penalized based on quality-of-care evaluations.
As the BCBSMA plans increase in popularity, health insurers state and nationwide are following suit. Speeding up the process will depend on streamlining payments to a single system as well as ensuring the insurer’s use of accurate data.
About the Author
Michael Moran is a Senior Vice President at WGA in the Employee Benefits Group, specializing in health and welfare insurance programs for WGA clients.