CareFirst BlueCross BlueShield launched yesterday a new program designed to reward physicians for practices that improve patients' health - an approach it believes could ultimately lower medical costs.
CareFirst, the region's largest insurer with about 3 million members, said it would pay doctors as much as 7 percent extra for meeting a variety of standards of care. Those measures are a mix of process (if women get needed mammograms), service (if there are weekend or evening hours) and outcomes (if patients lower their cholesterol).
The standards for bonus pay are taken from national organizations such as Medicare, medical specialty societies and the National Committee for Quality Assurance (NCQA), the accreditation body for health insurers.
CareFirst has been experimenting with limited bonuses for doctors as a way to improve care for more than a decade, but this is by far its largest effort.
"We wanted to have a more impactful kind of program," said Dr. Jon Shematek, CareFirst senior vice president and chief medical officer.
Improvements in measuring quality have made the broader program feasible, said Bruce Edwards, CareFirst senior vice president for networks management. "It's now possible to come up with a next-generation pay-for-quality program," he said.
With the program, CareFirst becomes a regional leader in a national movement to change the way doctors and hospitals are paid. Medicare has several demonstration projects under way, and most private insurers have launched programs under the banner of "pay for performance" (often shorthanded as P4P) or "pay for quality."
For example, Aetna Inc., a large national health insurer, announced yesterday that when it negotiates contracts with hospitals, it will seek to include clauses requiring the hospital to report serious medical errors to states and accreditation authorities. And Aetna says it doesn't expect to pay for the most serious errors, such as operations performed on the wrong body part.
Some insurers are making doctors' quality ratings available to consumers. Others are creating "tiered networks" with lower co-payments for patients who use doctors who score as cost-effective. CareFirst has no plans for either, so far, Edwards and Shematek said, but doesn't rule them out for the future,
