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Home / News & IndustryManaged Care Insight and Analysis
Updated: September 22, 2009
BCBSNC Finds Lower Healthcare Spending a Result Of Quality Incentives For Physicians

Bridges to Excellence, a pilot program conducted by Blue Cross and Blue Shield of North Carolina (BCBSNC), showed that through providing rewards to physicians- $4.2 million in rewards total- a higher level of quality standards could be met.

More than 970 physicians in the BCBSNC network, regardless of their participation in the pilot, achieved at least one quality standard as of April 2009, as compared with fewer than 100 physicians who were recognized as having met the standards at the beginning of the program. That is almost a tenfold increase in three years.

Nationally, 14,000 physicians representing 2,700 practices have met the program's quality standards.

The Bridges to Excellence pilot, launched in 2006, offered participation to physicians in one or more of its three programs: diabetes care, heart/stroke care, and physician practice management efficiencies.

In BCBSNC's data analysis, conducted by its Clinical Informatics unit at the conclusion of the pilot, it was found that:

  • Among diabetes patients, those who were treated by a physician meeting the Bridges to Excellence diabetes standards for care were much more likely to have a good blood pressure reading (defined as 130 over 80 or less).
  • Patients in the program for better efficiencies in practice management received high-cost radiology services, such as CT scans and MRIs, at a rate 12 percent lower than the control group of non-participating physicians.
  • These patients were also 34 percent less likely to visit the ER and 24 percent less likely to see a specialist.
  • The program included 194 physicians representing 41 practices, who earned rewards for meeting at least one quality standard.

Dr. Jennifer Lail, a pediatrician with Chapel Hill Pediatrics and Adolescents who participated in the pilot believes, "Ongoing self-assessment and quality improvement efforts are a critical part of any medical practice," and "the financial benefits of Bridges to Excellence have been very useful in continuing our quality improvement efforts."

Bridges to Excellence is a nonprofit organization with active programs in 17 states, sponsored by health plans, employers and physicians. The quality improvement program uses standards of care established by organizations such as the National Committee for Quality Assurance (NCQA).

"We've believed for years that quality improvement leads to better health outcomes and lower costs," said Don Bradley, MD, BCBSNC senior vice president and chief medical officer. "The healthcare quality movement is here to stay, and it's imperative that we keep the focus on quality as we embark on reforming the nation's healthcare system."

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


  This article was taken from:
Pay-For-Performance Reporter

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