DETROIT, Sept. 28 /PRNewswire/ -- Blue Cross Blue Shield of Michigan will reward 10 physician groups representing more than 2,900 physicians in 33 Michigan counties for improving quality of care and creating health care cost savings for more than 400,000 Michigan Blues members through an innovative monetary physician incentive program.
The goal of the Physician Group Incentive Program is to improve the quality of care for all affected members, but especially for those with four chronic conditions: congestive heart failure, coronary heart disease, persistent asthma and diabetes mellitus.
"The concept of using incentives is growing and shows that containing costs and improving quality of care are not incompatible," Thomas Simmer, M.D., Blues senior vice president and chief medical officer told representatives of the initial 10 physician groups chosen to participate in the program. The Blues hosted the groups during a conference today at the company's Lyon Meadows offices. Twenty-three physician groups had applied to take part. A portion of dollars set aside for fees will be made available for incentives.
Developed with input from physician discussion groups across the state, the program is the first of its kind by the Blues aimed directly at physicians who deliver care in its Traditional and PPO products. The program draws on the Blues' experience in rewarding quality care through other existing programs: the Blue Cross Blue Shield of Michigan Hospital Incentive Program, Blue Care Network HMO Physician Recognition Program and the Blue Cross Blue Shield of Michigan Physician Prescribing Pilot.
"They show that financial incentives can stimulate ongoing health care improvement. We can help physicians provide care consistent with evidence based guidelines while holding down costs and reward them for doing both," Simmer says.
The program will reward participating medical groups for developing the procedures and infrastructure to measure and improve the care of patients with the aforementioned chronic illnesses by sharing best practices amongst group members, as well as connecting patients to the services of BlueHealthConnection, the Blues' care management program. Here's how:
* Each physician group will develop a disease registry to systematically identify patients at high risk of complications and link this information to approaches to proactively reach out to these patients. This is expected to result in more effective long-term management of chronic illness.
* In addition to the four targeted chronic illnesses, physicians also will identify patients with one of the following conditions: low back pain, hysterectomy for benign uterine conditions, post-surgery chemotherapy for breast cancer, and men age 50 and older eligible for prostate specific antigen tests that detect possible prostate cancer. These patients will be referred to BlueHealthConnection's educational resources.
BlueHealthConnection is a Blue Cross Blue Shield of Michigan care management program that helps patients become more informed about their own health conditions so they can make better decisions about getting and staying healthy. A staff of BHC nurses keeps in contact with referred patients.
Materials available to patients include videos that provide expert information to give them a clearer understanding of treatment options they can then discuss with their doctor. A recent survey found that 94 percent of patients who had already used BHC said it helped them make informed medical decisions, take better care of themselves and improved interactions with their physicians.
* Physician groups will be measured for improvement in prescribing patterns for specific pharmacy measures promoting cost-effective prescription medications. Measures such as generic drug prescribing, average cost within select drug classes, and prescribing of specific medications according to national consensus guidelines will all be included.
* Physician groups also will measure and report their group's performance in providing care based on measurement methods available through the Michigan Quality Improvement Consortium and/or Health Plan and Employer Data and Information Set (HEDIS).
"In the long run, we hope to motivate ongoing positive, productive change in care delivery, and encourage best clinical and safe practices. We also expect to see measurable improvements in the care of chronic diseases, improved outcomes for patients with one of the four targeted conditions, enhancement of each physician group's infrastructure to support clinical improvement programs, plus increased effectiveness of BlueHealthConnection's patient education and shared decision-making efforts," Simmer says.
By rewarding care improvements, lower overall care costs will result from keeping patients healthier, resulting in fewer lost work days and lowered prescription costs, reducing avoidable hospital admissions and lengths of stay and fewer complications for in-hospital patients, he adds.
Future eligibility to participate in the program is contingent on meeting the outlined performance improvement goals. A group's share of the incentive is based on their performance in meeting program expectations and the number of Blue Cross Blue Shield of Michigan members.
The 10 participating groups are: Genesys Integrated Group Physicians and McLaren Medical Management, Inc., Flint; Huron Valley Physicians Association, P.C., and University of Michigan Health System Faculty Group Practice, Ann Arbor; Michigan Medical P.C. and Regional Delivery Network of West Michigan, Grand Rapids; ProMed Healthcare, Kalamazoo; Sparrow Family Medical Services, Lansing; Medical Network I, P.C., Rochester, and St. John Health, Medical Resource Group, Detroit. They treat patients in these counties: Allegan, Barry, Bay, Calhoun, Clinton, Eaton, Genesee, Gratiot, Ingham, Ionia, Jackson, Kalamazoo, Kent, Lapeer, Lenawee, Livingston, Macomb, Mason, Monroe, Muskegon, Newaygo, Oakland, Oceana, Ogemaw, Oscoda, Ottawa, Saginaw, Shiawassee, St. Clair, St. Joseph, Van Buren, Washtenaw and Wayne.
Blue Cross Blue Shield of Michigan, a nonprofit corporation, provides health care benefits to nearly 4.8 million members through a variety of plans: Traditional, Blue Preferred and Community Blue PPOs, Blue Choice Point of Service, and the Blue Care Network HMO. Blue Cross Blue Shield of Michigan and Blue Care Network are nonprofit corporations and independent licensees of the Blue Cross and Blue Shield Association. For more information, visit http://www.bcbsm.com/ .
Blue Cross Blue Shield of MichiganCONTACT: Helen Stojic, +1-313-225-8113, or Bill Semion, +1-313-225-7975,mediarelations@bcbsm.com , both of Blue Cross Blue Shield of Michigan
Web site: http://www.bcbsm.com/
