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Blue Cross incentive plan focuses on primary care

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Primary care doctors could earn as much as 30 percent more in a medical quality incentive plan that Blue Cross and Blue Shield of Georgia will launch July 1.

The president of Blue Cross of Georgia, Morgan Kendrick, said the incentive pay program will begin in Athens, Rome, Columbus and Savannah, with more than 250 physicians serving 58,000 patients.

The company will roll out the program in the Atlanta market and elsewhere in the state over the rest of the year, Kendrick said.

Blue Cross is the leading health insurer in Georgia, with more than 2 million members.

Physicians will get a per-member per-month management fee, plus other opportunities to earn higher reimbursement for better medical outcomes for patients, Kendrick said.

Primary care offices would have longer hours, plus a 24-hour call center.

The Blue Cross plan appears similar to the "patient-centered medical home" concept. These primary care practices coordinate care for all a patient's needs, including managing chronic diseases such as asthma and diabetes and delivering other services that aren't now reimbursed.

Other insurers have also created medical homes in the state. Five Kaiser Permanente of Georgia medical facilities in metro Atlanta have been designated as medical homes — in east Cobb County, Lawrenceville, Holly Springs, Sugar Hill/Buford and Cumberland, also in Cobb County.

Aetna has a medical home arrangement with Emory Healthcare for Medicare members, and one for Emory employees and their dependents who are insured by Aetna.

Such payment arrangements continue a fundamental shift in reimbursement that insurers and employers are pursuing, where medical providers are paid for the quality of care, instead of the quantity of services they deliver.

Doctors like the WellPoint program because “they practice medicine like they want to practice," Kendrick said.

Kendrick said the WellPoint plan, announced last year, has been successful in Colorado, New Hampshire and other markets.

A WellPoint official told FierceHealthPayer in May that the company had recruited 11,000 primary care doctors for the new program nationally, both large practices as well as small, independent physician offices.

Kendrick also said Tuesday that Blue Cross is working on developing accountable care organizations in Georgia. These combinations of physicians, hospitals and insurers seek to deliver high-quality, efficient medical care, and were promoted in the 2010 health reform law.

For more from Georgia Health News, go to www.georgiahealthnews.com

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