Specialists to share the wealth in Massachusetts Blues bonus plan

The incentive-based pay system will reward both primary care physicians and larger multispeciality groups.

By Mike Norbut, AMNews staff. Jan. 13, 2003.

Massachusetts' largest health insurer has created a new bonus plan that rewards physicians based on both quality and cost control, and it plans to incorporate specialists into the payment plan.

Blue Cross Blue Shield of Massachusetts, which already has a quality-based bonus system for primary care physicians in its HMO network, is rolling out its HMO Blue Group Performance Incentive Program this month. Groups representing about 8,000 physicians already are enrolled, and Blues officials expect to expand the program in 2004.

Larger multispecialty groups -- those serving more than 8,500 HMO Blues members -- will be eligible for up to a 10% bonus above the normal fee schedule, according to plan officials. The bonuses will be applicable to both capitated and fee-for-service contracts, and groups will be expected to share the bonuses with the individual physicians, namely specialists, said James Fanale, MD, chief medical officer for the Massachusetts Blues.

"We firmly believe you cannot have an incentive-based pay system and ignore both sides of the equation," Dr. Fanale said. "This puts together specialists and primary care physicians. We wanted to involve the specialists."

Massachusetts Medical Society President Charles A. Welch, MD, said he approved of combining quality and cost measures, provided the criteria didn't put physicians in an ethical dilemma. He also applauded the general efforts of paying for performance, though he said plans needed to align their measurements to make it easier for doctors to participate.