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Independence Blue Cross launches P4P physician payment with medical home component

Independence Blue Cross (IBC) in Philadelphia is investing an additional $47 million a year to launch a pay-for-performance payment model for primary-care physicians in its southeastern Pennsylvania provider network that includes incentives for physicians who qualify as a patient-centered medical home, reports the Philadelphia Inquirer.

Of that $47 million, more than $33 million will be tied specifically to incentive payments for providing better care. Physicians will have the opportunity to double their incentive earnings over IBC's program for last year. For example, a physician with 850 Keystone HMO patients could earn an additional $150,000 a year, Steven Udvarhelyi, executive vice president of health services at IBC, tells the Inquirer. "We think this is a significant opportunity for primary-care physicians who are doing a good job. It is a great incentive for them to improve over time."

Effective July 1, IBC's pay for primary-care physicians will be based on three components:

  • Base reimbursement: Network primary-care doctors will see an average 10 percent increase in base reimbursement for services.
  • Incentives for improving quality outcomes: The Quality Incentive Payment System (QIPS) will reward primary-care physicians who perform well on process measures and quality outcomes (e.g., proper blood sugar testing, cholesterol screening, and eye exams when treating diabetic patients; breast, cervical and colorectal cancer screenings; childhood and adolescent immunizations; and the management of asthma and cardiovascular conditions) compared to peers in the same specialty, such as family or general practice, internal medicine or pediatrics. The higher physicians perform on the QIPS measures, the greater their potential incentive payments. In addition, to boost patient compliance and physician use of quality metrics, IBC will offer "meaningful incentives" to primary-care physicians who meet some or all of the core requirements of the patient-centered medical home model. IBC was inspired by the early successes of the Pennsylvania Chronic Care Initiative, a patient-centered medical home demonstration project that includes more than 170 medical practices and 1.1 million patients across Pennsylvania. For example, participating diabetics have seen an improvement of almost 25 percent in blood-sugar levels and blood pressure, says Udvarhelyi.
  • Incentives for managing medical costs: QIPS also will reward doctors who provide effective care coordination (e.g., discuss risks, benefits and value of treatments with patients) across the healthcare continuum.

Concurrent with the implementation of these three components, IBC also will modify its payments for "costlier, episodic, specialty care services, which can often be avoided with regular, effective preventive care," says a company press release. About 1,800 family and general practitioners, internal medicine practitioners and pediatricians who provide services to IBC's commercial and Medicare Advantage HMO and point-of-service members are eligible to participate.

To learn more:
- read this Philadelphia Inquirer article
- read this Healthcare Finance News article
- read the IBC press release
- visit the Pennsylvania Chronic Car Initiative website
- review the National Committee for Quality Assurance's Patient-Centered Medical Home standards

Related Articles:
HMO pay for performance plans common
Study: P4P works with proper incentives
Missouri Blue plan kicks off medical home pilot

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