BCBS of MA plans reimbursement changes

Blue Cross and Blue Shield of Massachusetts, the dominant health insurer in the state, is making a major change in the way it pays its physicians. It's moving from fee-for-service payments to offer per-patient per-year capitation rates, adjusted for age and sickness--plus a major bonus for providers who improve a patient's health status. Under the new plan, the BCBS plan hopes to lay off a great deal of risk, presumably on the primary care groups. Typically, the capitation will cover all primary care, specialist, counselor and hospital costs. Interestingly, BCBS has publicly denied that this system is "capitation" (apparently a dirty word), and assured the public that it has safeguards in place to make sure that patients won't be undertreated or lack choice and doctors won't be underpaid. Though you know, it seems to me that if it quacks like a capitation, it is one.

By making these changes, BCBS of Mass hopes to cut the growth in medical costs in half in two to four years among providers who accept the capitation. (The notion is that providers can have a particularly large impact on the cost of managing chronically-ill patients effectively.) It's also thinking it will attract more business as costs fall into line.

To learn more about the Blue plan's reimbursement changes:
- read this piece from The Boston Globe

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