Anthem BCBS of Indiana Climbs On Board the Pay-For-Performance Bandwagon

Medicare implemented its Physician Quality Reporting Initiative,which is also known as PQRI. Doctors who satisfied the quality of care and reporting requirements under PQRI received bonuses equal to 1.5% of their 2007 reimbursements.

A very limited number of small to medium size practices have opted to participate in PQRI due to the onerous reporting requirements (which, realistically speaking, can only be satisfied by EMR users) and the modest financial incentive. While providers have not embraced Medicare’s PQRI, many have been more receptive of the quality of care initiatives launched by such commercial payers such as Blue Cross Blue Shield.

Anthem Building

Anthem Blue Cross and Blue Shield of Indiana (Indiana BCBS) has just announced that it will be following the emerging industry trend of offering bonuses to providers who follow its quality of care recommendations. Indiana BCBS’s bonus program, which is focused on primary care providers, will allow providers to earn a bonus equal to as much as 10% of their annual reimbursements.

As to the mechanics of the program, the Indianapolis Star explains that it is “based on information gleaned from the Indiana Health Information Exchange’s Quality Health First program… an Indianapolis-based nonprofit company that operates a widely used messaging service that allows thousands of area health-care providers to access lab results and other medical information securely over the Internet. Such data allows IHIE to generate reports for its Quality Health First program that tells doctors which of their patients have received recommended screenings and care.”

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