Beth Israel Physicians Group Moving Towards New Blue Cross Care Model

Last week Blue Cross announced their plan for employers to encourage the use of those on the “low” list versus the “high” group and as you can see from the link below there are 15 on the “high” list to where it will cost the patient more and will have higher premiums. This agreement is at the hospital level with insurers.

Blue Cross Launching New Health Coverage Option in Massachusetts-Encourages Consumers Via Employer Plans to Avoid 15 Named High Cost Hospitals

“Alternative Quality Contract” is what is being introduced here with Blue Cross and the physician’s group, giving doctors a budget of sorts to work with and when reconciling if they stay under budget, the physicians group keeps the change and splits with Blue Cross and the same is said for the over budget provisions, they both split the cost. The article says doctors are a little nervous, and who isn’t these days with a new process being tried as sometimes you never know who it will work until everything is played out. It may mean some adjustments in billing but I believe that is more over at the insurer’s side. This appears to be solely between the insurance company and the physician’s group. You can also read more over at Paul Levy’s blog, “Running a Hospital” for more details and information. BD

BOSTON — If you feel the earth shaking near Beth Israel Deaconess Medical Center in the next few months, it may be the rumble of 1,800 physicians adjusting to a new way to deliver and get paid for care. These doctors are the latest and largest physicians group to sign a global budget contract for HMO patients at Blue Cross — and many are uneasy.

“There’s guarded optimism, there’s outright anxiety, there’s everything in between,” said Rich Parker, medical director at the Beth Israel Deaconess Physician Organization.

Now, instead of getting paid for every visit, test and procedure, doctors at Beth Israel will receive a budget to care for their 75,000 to 80,000 Blue Cross HMO patients. If the physicians group goes over-budget they split the loss with Blue Cross. If they come in under budget, they share the surplus, based on how much they improved the care of patients with say, high blood pressure, cholesterol or diabetes. If the doctors can’t show improvement in patients’ conditions or that patients are getting more preventative tests, they don’t share the surplus.

There will be both health and financial incentives to keep patients at Beth Israel Deaconess. If patients go to some other hospital, these doctors would have to pay the rival hospital’s bill and may not have easy access to their patients’ records. Both Beth Israel and Blue Cross say the contract will save money over time but they are not sharing details. Primary care doctors will take the lead in managing a patient’s care under this contract — and that’s where another major change comes in.

Beth Israel Doctors Take Risk For Managing Care | WBUR