IBC to pay doctors for quality, using new pay-for-performance model

Independence Blue Cross will compensate its in-network doctors with a pay-for-performance model, a move it says will save money while improving the quality of health care.

The shift would be a departure from the current system, made popular in the 1970s when health maintenance organizations put the focus on the number of patients seen. In the recent debate over health care reform, pay-for-performance models were considered one means of lowering the cost of health insurance.

The Philadelphia, Pa.-based insurer, the second largest health insurer in the state, said it will invest an additional $47 million to supplement primary care doctors’ compensation. More than $33 million of this added investment will fund an enhanced incentive program where physicians may earn additional compensation for providing better care, not more care. The new incentive program offers primary care physicians the opportunity to double their incentive earnings over last year’s program by providing “excellent care and service” to IBC’s commercial and Medicare Advantage HMO and Point-of Service members, the insurer said in a statement.

The changes, effective July 1, will affect about 1,800 family and general practitioners, internal medicine practitioners, and pediatricians participate in IBC’s health care provider network in southeastern Pennsylvania.

Recruiting, retaining top-notch doctors

The average increase for in-network doctors is about 10% for primary care doctors, marking the largest boost in compensation in the last five years.

Its changes to reimbursements are aimed at helping to attract and retain high performing primary care physicians by rewarding them for the vital role they play in delivering quality care to IBC’s members, the insurer said. At the same time, IBC is modifying its reimbursement for costlier, episodic, specialty care services, which can often be avoided with regular, effective preventive care.

“IBC is a strong advocate for changing the health care system to enhance the affordability and quality of health care,” said Joseph A. Frick, president and chief executive officer at IBC, in a statement. “Real and sustainable health care reform includes collaborating with our physician and hospital partners by enhancing incentives for providing safer, higher quality, and more cost-effective care – rather than just more care.”

The new incentive payment model, known as Quality Incentive Payment System or QIPS, will reward primary care physicians who improve the quality of care compared to nationally accepted standards of quality care like proper blood sugar testing, cholesterol screening, and eye exams when treating diabetic patients, and other measures such as breast, cervical and colorectal cancer screenings, childhood and adolescent immunizations, and the management of asthma and cardiovascular conditions.

Doctors will be rewarded based on process measures and quality outcomes compared to peers in the same specialty such as family or general practice, internal medicine, or pediatrics. The highest performing physicians have the greatest incentive earning potential in addition to their base reimbursement.

QIPS also will reward doctors who effectively manage physician and outpatient services by coordinating the integration of their patients’ care across the continuum of health care services. Providing incentives to improve care coordination encourages physicians to take the time needed not only to discuss the risks and benefits of certain procedures or treatment, but also to help patients understand the value of the treatment – for example, understanding the benefits of non-invasive, conventional treatment versus a diagnostic or invasive procedure, the insurer said.

Nationally, IBC and its affiliates provide coverage to nearly 3.3 million people