Incentive program results are in

An incentive program introduced by Independence Blue Cross (IBC) in 2010 allows primary care doctors to double their base reimbursement. It paid out nearly $37 million in 2011, rewarding physicians for improving the quality of care and providing care in a more efficient way in an attempt to control the cost of care.

IBC revised its Quality Incentive Payment System (QIPS) in early 2010. Through its new incentive program for primary care physicians, IBC began offering additional financial rewards to primary care practices that meet some, or all, of the National Committee for Quality Assurance’s (NCQA) core requirements to become a nationally recognized Patient-Centered Medical Home (PCMH). Since IBC began providing incentives for PCMH through its enhanced incentive program, the IBC network has grown from 32 PCMH-certified practices to approximately 240, according to Doug Chaet, Independence Blue Cross senior vice president.

“IBC believed that a significant enhancement to physicians' earnings opportunity-and the introduction of medical cost and PCMH recognition incentives-were critical additions to the evolving QIPS primary care incentive program, which already contained quality and generic prescribing measures,” says Chaet. “IBC's strategy seeks to align incentives across the continuum and promotes vertical integration between primary care physicians, specialists, and hospitals, to enhance care coordination.”

In addition to earning additional pay for running their practices as medical homes, doctors can earn QIPS incentives based on achievements in the following three additional areas:

1. Coordinating cost-effective care. IBC’s analysis has shown that if every eligible physician achieved top-tier status, medical cost spending in the Philadelphia area could be reduced by an estimated $60 million, and high-performing physicians would be rewarded an additional $20 million in incentives.

2. Prescribing generic drugs. Over the past decade, IBC has seen a 63% increase across all primary care specialties in generic drug prescribing rates.

3. Delivering quality care. Physicians participating in the incentive program performed at or above the 75th percentile benchmark in 20 quality performance measures.

“The addition of the medical cost component has fostered collaboration and awareness across the network, as primary care physicians are working with IBC to review their medical cost performance to identify areas of unnecessary utilization, which lead to higher costs,” says Chaet. “On the other hand, the PCMH model is critical to enabling primary care physicians to create improved access, coordination and quality of care for members.

Go back to the Managed Healthcare Executive eNews newsletter.