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
introduced a new reimbursement model for participating primary care
Under its Blue Quality Physician Program, about
primary care physicians across the state have applied for the higher
"For too long our healthcare system has been built
paying for the volume of procedures rather than the quality of
outcomes," said Dr. Don Bradley, BCBSNC senior vice president and chief
medical officer. "Blue Quality Physician Program is our way of getting
incentives where they belong – with quality outcomes, not
The program is open to North Carolina primary care
physicians – family and general practitioners, internists,
pediatricians, obstetricians and gynecologists – who agree to
company’s standard contract for in-network physicians.
Bonuses are based on participating physicians
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
improve efficiency, but often don’t have the resources to
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
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
health care," said Milo Brunick, BCBSNC vice president of network
Participating physicians in the Blue Quality
Program earn higher reimbursement by achieving standards in clinical
quality outcomes, administrative efficiency and patient experience with
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.