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IBC rewards cost-effective, patient-centered primary care with enhanced incentive program

Nearly $37 million in incentives – the largest incentive IBC has ever paid primary care doctors

Philadelphia, PA – An innovative incentive program introduced by Independence Blue Cross (IBC) in 2010 is leading the way nationally by rewarding high-performing primary care physicians for providing excellent, patient-centered care. The program, which allows primary care doctors to double their base reimbursement and paid out nearly $37 million in 2011, rewards physicians for improving the quality of care and providing care in a more efficient way, which helps control the cost of care – all part of IBC’s commitment to transforming the delivery of health care in our region.

IBC revised its progressive incentive program, the Quality Incentive Payment System or QIPS, in early 2010 to attract and retain high-performing primary care physicians in southeastern Pennsylvania, as well as to motivate and encourage doctors to improve quality and provide care in a more efficient way, which helps control rising health care costs. Doctors received their first payments under the new incentive program in 2011, the largest incentive IBC has ever paid primary care doctors.

“We believe that by building a strong partnership with the physicians and hospitals that care for our members, we can — together — transform the delivery of health care in our region,” said Daniel J. Hilferty, IBC president and CEO. “Through our path-finding, highly rewarding incentive program for primary care physicians we are setting a new standard among health insurers nationally for progressive payment programs that reward the medical community for delivering the best possible care to members in the most cost-effective way.”

One of the more than 3,000 physicians eligible to participate in this incentive program is Dr. Richard Wender, chair of the Department of Family and Community Medicine at Thomas Jefferson University, who believes: “If every insurer were doing what IBC is doing [with primary care incentives], this would provide a much better chance for primary care to truly transform health care for the nation.”

“I appreciate the collaboration I have with Independence Blue Cross,” adds Dr. Wender. “IBC understands the pivotal role that primary care physicians play in the health of its members — and they have created a way to demonstrate this commitment through their enhancements to maximize QIP’s effectiveness. Stronger incentive programs help physicians, hospitals, and health insurers work more closely to encourage adoption of healthy lifestyles, uptake of preventive care, and better chronic care management.”

Rewarding ‘Patient-Centered Medical Homes’
Through its new incentive program for primary care physicians, IBC began offering additional financial rewards to primary care practices that meet some, or all, of the National Committee for Quality Assurance’s core requirements to become a nationally recognized Patient-Centered Medical Home. Medical homes use a team approach and support the primary care physician with health educators, nurse practitioners, and other health care professionals. Patients who are cared for in a medical home typically have more timely access to their physicians. In addition, the practices are organized so that care managers and health educators help chronically ill patients receive key tests, take medication as directed, and maintain their optimal health status.

“We are proud that we are one of the first health insurers in the country to successfully integrate medical home incentives into our physician incentive program,” says IBC CEO Hilferty. “Since the beginning of 2011, the number of recognized medical home practices in our networks has more than tripled to nearly 200 in southeastern Pennsylvania, bringing this revolutionary delivery of care to more than half a million IBC members.”

“We designed our incentive program for primary care physicians to be among the most comprehensive and rewarding in the United States, encouraging our doctors to improve performance and help control costs,” says Doug Chaet, IBC’s senior vice president of Contracting and Provider Networks. “The program provides physicians with clear performance goals that keep the bar high on delivering quality, efficient care to help increase health care affordability in our community.”

Rewarding high quality cost effective care
In addition to earning additional pay for running their practices as medical homes, doctors can earn QIPS incentives based on achievements in the following three additional areas:

  • Coordinating cost-effective care. In the first year of the revised incentive program, roughly 20 percent of eligible physicians achieved top-tier performance by delivering the highest level of cost-effective care through improved coordination of care for their patients’ physician visits, lab tests, and other outpatient services. The program’s medical-cost performance targets are based on the average cost and use of health services of each physician’s patient population. IBC’s analysis has shown that if every eligible physician achieved top-tier status, medical cost spending in the Philadelphia area could be reduced by an estimated $60 million, and high-performing physicians would be rewarded an additional $20 million in incentives.
  • Prescribing generic drugs. IBC’s primary care incentive program has long-rewarded physicians for prescribing generic equivalent drugs instead of higher-cost brand name drugs because this reduces costs while still providing excellent care. Over the past decade, IBC has seen a 63 percent increase across all primary care specialties in generic drug prescribing rates. Increased use in generics translates to increased savings for consumers and private and public insurers. According to the U.S. Food and Drug Administration, generic medications can cost consumers up to 80 percent less than their branded counterparts. Data from the Centers for Medicare & Medicaid Services show that for every two percent increase in generic use, Medicaid saves an additional $1 billion annually.
  • Delivering quality care. Physicians participating in the incentive program show unprecedented compliance with nationally accepted standards of quality care — performing at or above the 75th percentile benchmark in 20 quality performance measures that address a broad range of important health concerns such as heart disease, asthma, diabetes, and preventive measures such as cancer screenings. This means IBC’s physicians who participated in the incentive program were as successful as the top 25 percent of the highest-performing doctors nationwide in delivering high quality care.

Research has shown that providing effective clinical preventive and chronic management services like lowering patients’ blood pressure or controlling their diabetes can improve patient health and wellness, as well as mitigate the need for higher-cost interventions and care such as hospital stays and emergency department visits.