BCBSNC Sets New Reimbursement Model For Primary Care Physicians

Another BCBS plan is carrying the mantel for quality and rewarding those physicians who do so with bonuses.

BlueCross and BlueShield of North Carolina (BCBSNC) introduced a new reimbursement model for participating primary care physicians.

Under its Blue Quality Physician Program, about 4,000 primary care physicians across the state have applied for the higher reimbursement structure.

"For too long our healthcare system has been built on paying for the volume of procedures rather than the quality of outcomes," said Dr. Don Bradley, BCBSNC senior vice president and chief medical officer. "The Blue Quality Physician Program is our way of getting incentives where they belong –with quality outcomes, not volume."

The program is open to North Carolina primary care physicians – family and general practitioners, internists, pediatricians, obstetricians and gynecologists – who agree to the company’s standard contract for in-network physicians.

Bonuses are based on participating physicians meeting nationally recognized, evidence-based standards for quality of care. The reimbursements can be double-digit increases over the BCBSNC standard fee schedule for some of its most commonly billed codes.

"Physicians understand the need to measure quality and improve efficiency, but often don’t have the resources to upgrade their office infrastructure and evaluate results," said Dr. Joseph Ponzi with Goldsboro Pediatrics in eastern North Carolina.

The Blue Quality Physician Program succeeds the insurer’s Bridges to Excellence quality improvement program that operated much the same as the Blue Quality program.

"Healthcare is embracing quality and efficiency standards, which also offers promise for improving the affordability of healthcare," said Milo Brunick, BCBSNC vice president of network management.

Participating physicians in the Blue Quality Physician Program earn higher reimbursement by achieving standards in clinical quality outcomes, administrative efficiency and patient experience with care.

BCBSNC serves more than 3.7 million members.

Address: Blue Cross and Blue Shield of North Carolina, 5901 Chapel Hill Rd., Durham, NC 27707; (800) 250-3630, www.bcbsnc.com.