Blue Quality Physician Program
Program Location:
Raleigh, NC
Payer Type:
Commercial
Parent Program:
Payers:
BlueCross BlueShield North Carolina
Reported Outcomes
Description:
Blue Cross Blue Shield North Carolina introduces Blue Quality Physician Program on the heels of its successful Bridges to Excellence quality improvement program, which concluded in April 2009. Under its Blue Quality Physician Program, about 4,000 primary care physicians across the state have been invited to apply for the higher reimbursement structure. The program is designed to reward quality over quantity in the delivery of medical services.
Payment Model:
Participating physicians who meet a set of criteria that includes nationally recognized, evidence-based standards for quality of care are eligible for reimbursement that offers double-digit increases over BCBSNC’s standard fee schedule for some of their most commonly billed codes. BCBSNC will reimburse at a higher level once the physician is approved for the program.
Fewer ED / Hospital Visits:
- 52% fewer visits to specialists
- 70% fewer visits to the ER
- Inpatient admissions also decreased in the QBPC group, most significantly among those with chronic conditions (P <.05).
Cost Savings:
Average total cost increased in both the QBPC and control groups in 2014, but the increase was significantly less in the intervention group—a difference of $27.09 per member per month (PMPM) (P ≤.001). Savings in total cost were derived largely from a decrease in hospitalizations—a difference of $18.85 PMPM (P = .0023).
Increased Preventive Services:
Savings were associated with shifts in healthcare utilization by the intervention group toward proactive management, including increased primary care physician visits (P = .0106) and higher screening rates for diabetes (P = .0019).
Last updated March 2019
