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California Blue Cross offers quality pay incentive plan for PPO

Physicians aren't jumping at the chance to sign up for the program, which could bring a $5,000 bonus.

By Mike Norbut, amednews staff. Nov. 11, 2002.

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Physicians may question its design or implementation strategy, but in a rare move, one of California's largest health plans is planning to extend its physician quality incentive program to its PPO.

Blue Cross of California, which last year initiated a quality scorecard for physicians who had contracted with its HMO, is expanding the scorecard system to individual physicians with promises that the quality criteria will not put any undue stress on the doctors who participate.

The Blue Cross plan, which would award a $5,000 bonus to its highest-scoring PPO physicians, is one of a growing number of programs across the country that bases incentives on quality rather than cost control. Several insurers, including Indianapolis-based Anthem and Blue Cross Blue Shield plans in Massachusetts and Illinois, also have physician quality initiatives.

The Centers for Medicare & Medicaid Services recently announced that it, too, was starting a quality pilot program, initially offered to groups of 200 physicians or more.

Industry analysts are calling the Blue Cross plan -- which would affect 4.1 million PPO members in California, about double the number of people enrolled in the Blue Cross HMO plan -- a giant step forward. Its focus extends beyond the large medical groups, which until now have been the primary targets of most incentive programs.

The plans produce results, advocates say. For example, the Illinois Blues plan, owned by Health Care Service Corp., reports that only 2% of physician groups participating in its quality program in 1998 had a 70% or higher rate of women who had a Pap smear, but 34% of groups reached that target in 2000. [...]