Rewarding Primary Care Physicians for Improving Health Outcomes

September 20, 2010

Medical home project promises primary care doctors better reimbursement for preventive care and improved outcomes in patients with chronic illnesses.

An article published in the Baltimore Sun notes that state health officials in Maryland have approved an insurance company-devised plan to “reward primary physicians for improving health outcomes for patients.”

Submitted by CareFirst BlueCross BlueShield, the plan was approved as part of the Maryland Healthcare Commission’s medical home project. The Sun article notes that the plan is “designed to encourage doctors who participate to focus on treating the sickest patients,” in the hopes that more illnesses will be caught early if more people visit primary care physicians. In turn, this would “prevent more serious — and costly — conditions down the road.”

Under the program, doctors would “form panels or practices of five to 20 primary care physicians so they can pool resources to treat patients.” According to CareFirst, participation in the medical home project is entirely voluntary and physicians who participate can earn meaningful reimbursement increases in three ways:

  • 12% point increase added to current fee schedule
  • New fees for developing care plans for select patients with certain chronic or multiple conditions that put them at risk and for monitoring progress against those plans
  • Additional fee schedule increases (up to an 80-point increase) based on physicians’ engagement with their patients, the quality of care delivered to their entire cohort of patients, and actual aggregate costs of care compared to expected costs

Chet Burrell, CareFirst President and CEO, said that “Everyone recognizes that the rising costs associated with health care are unsustainable and threaten to make health care unaffordable for families and individuals. We believe that improving care quality and slowing rising health care costs go hand in hand… The PCMH program is our effort to address these challenges. The program will meaningfully compensate physicians for placing an increased emphasis on caring for their sickest patients, and reward them for making measurable improvements in quality and efficiency.”

A key selling point for the cash-strapped and/or technophobic practitioner may be that “Panels can be formed by existing practices, and smaller practices can participate by combining to form “virtual” medical panels — ensuring that primary care practices of any size can join the program. PCMH is voluntary, and physicians are not required to purchase electronic health record systems or hire additional staff to participate.” (emphasis added)

HCPLive wants to know:

If you are a primary care physician in Maryland, do you plan to participate in this program? If not, what are your reasons for declining?Have other states enacted similar programs in partnership with insurance companies? If any readers are currently participating in such a program, what has the experience been like? Have the promised additional fees been forthcoming?