Highmark wants to put focus on getting best value for patient’s medical dollar

PHOTO PROVIDED Dr. Quentin Novinger, medical director for Highmark Blue Cross Blue Shield, reviews medical information with Crystle Blanco, RN, manager, prior authorization.

Highmark Blue Cross Blue Shield has rolled out a program that rewards primary doctors for a job well done.

Dr. Quentin Novinger, Blue Cross medical director, said the program, True Performance, simply is a step toward taking better care of patients.

“It’s being done with all primary-care providers for commercial and Medicare Advantage members,” he said.

Novinger said it’s a model that health care increasingly might be moving toward.

It encourages doctors to take a bigger role in managing their patients’ health and moves away from a payment model that rewards the volume of care to one that emphasizes good value for dollars spent.

“It’s a better way of taking care of patients,” Novinger said.

“This can give them the care they really need,” he said.

Under True Performance, primary-care physicians must meet certain quality and cost measures to earn the incentives, according to Blue Cross officials.

In addition, they must ensure their patients receive certain preventive and treatment services to keep them healthier, such as childhood immunizations, appropriate drug therapy for chronic diseases, cancer screenings and annual wellness exams.

Part of the goal is to help avoid more costly care later.

Physicians receive a 10 to 30 percent increase over what they make currently based on their quality and cost performance.

The program kicked off Jan. 1.

Blue Cross spokesman Anthony Matrisciano noted physicians are paid out of a bonus pool of dollars with their performances measured based on industry standards defined by Centers for Medicare and Medicaid Services.

Officials say another positive aspect of the program is a monthly per-patient fee that physicians receive for care coordination.

The money is invested to improve patient convenience — offering later appointments, hiring staff members to call and check on patients.

Novinger dismissed notions of True Performance driving up insurance premium costs.

“Our thought is over time that this will help contain costs,” he said.

The program includes independent physicians, but not those employed by hospitals such as UPMC Susquehanna and Geisinger Medical Center, Matrisciano said.