BCBS of Massachusetts puts Beth Israel doctors on budget

Blue Cross Blue Shield of Massachusetts and the Beth Israel Deaconess Physician Organization have signed an alternative quality contract, thereby covering 40 percent of Blue Cross HMO members under so-called "global payments." The move is a signal that global payments, a system designed to reward doctors for keeping patients healthy and reducing the number of medical procedures, is gaining traction among Massachusetts doctors, reports the Boston Business Journal.

The agreement sets a global, or fixed, payment per patient adjusted for age, sex, and health status as well as payments tied to performance on quality measures, health outcomes and patient care experiences. The contract's global payment covers all services received by a patient, including primary, specialty and hospital care, Blue Cross officials said in a statement.

Now, instead of getting paid for every visit, test and procedure, doctors at Beth Israel will receive a budget to care for their Blue Cross HMO patients. If the physicians group goes over-budget, they split the loss with Blue Cross. If they come in under budget, they share the surplus, based on how much they improved the care of patients with certain conditions. If the doctors can't show improvement in patients' conditions or that patients are getting more preventative tests, they don't share the surplus, WBUR reports.

Beth Israel is the largest physicians group to join the Blue Cross payment system since the insurer started advocating for this contract two years ago. "It's rooted in a group that initially was skeptical," Blue Cross CEO Andrew Dreyfus told WBUR. "It took a long time for the group to come around and I think by the way our discussions with them improved (the contract)."

This new way of paying for healthcare already seems "very encouraging," Dreyfus said. "Quality is improving at a faster rate with physicians who are practicing under our new payment model than with physicians who are outside of our payment model."

To learn more:
- read the WBUR story
- check out the Boston Business Journal article
- see the BCBS press release

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