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Home / News & IndustryManaged Care Insight and Analysis
Updated: June 1, 2011
Empire Debuts P4P For New York Physicians

Empire BlueCross BlueShield, the largest insurer in New York, is unveiling a P4P program to reward doctors who comply with certain best practices. It won’t penalize those who fall short.

Empire plans to use claims data to better monitor whether physicians are complying with widely accepted medical best practices.

Other Blue Cross Blue Shield plans across the country have unveiled similar programs, including Anthem in Connecticut.

The New York program, available for all commercial plans, includes an additional 3 percent to 5 percent above the standard fee schedule for visit codes as of August 2010.

Dr. Scott Breidbart, Empire’s CMO, said the insurer wants to use the method and the money not only to reward best practices but to encourage doctors to adopt them.

"Other doctors will not be penalized," he said. "We want all doctors to earn the top reward. The better the care our members get, the better off we all are. The doctors have not yet seen the enhanced fee issue, but nobody ever complains about getting more money."

Doctors, Breidbart said, would be rewarded for a good overall score on benchmarks, such as making sure patients are immunized and giving diabetes patients a hemoglobin test to measure blood sugar.

Standards of excellence will also be factored into scores and include use of electronic health records, statins for patients with coronary artery disease, beta blockers for patients after a heart attack, avoiding unnecessary antibiotics for adults with bronchitis and children with an upper respiratory infection.

Doctors’ scores would also be boosted by certifications from the National Committee for Quality Assurance.

"Practicing doctors are our partners," Breitbart said. "We have to work with them to improve health care."

Empire will allow doctors to provide additional information that could allow them to qualify for better reimbursement, even if at first they fall short, he said.

"We also recognize that claim data is not always perfect. We do give doctors the opportunity to point out where we may be missing information," he added.

Address: Empire BlueCross Blue Shield, One Liberty Plaza, New York, NY 10006; (212) 476-1000,

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

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