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Highmark delays episode payments for specialists
Capitation Management Report
|November 7, 2000
Insights
Highmark Blue Cross and Blue Shield delayed payment changes for specialty physicians due to opposition and reported issues. The new payment system for Medicare Health Maintenance Organization (HMO) members will be implemented in early 2001.
Area of Science:
- Healthcare policy
- Medical economics
Background:
- Highmark Blue Cross and Blue Shield faced significant opposition from specialty physicians.
- Concerns were raised regarding national reports of problems with similar payment systems.
Purpose of the Study:
- To report on Highmark Blue Cross and Blue Shield's decision regarding changes in physician payment.
- To outline the timeline for implementing new payment structures for specialty care.
Main Methods:
- Qualitative analysis of physician feedback and national system reports.
- Policy review and decision-making by Highmark administration.
Main Results:
- Highmark Blue Cross and Blue Shield will postpone the implementation of new payment changes.
- The delay is a direct response to physician opposition and system-related issues.
Conclusions:
- The decision to delay reflects a need to address physician concerns and system vulnerabilities.
- Further evaluation and potential modifications to the payment system are anticipated before implementation.
Abstract:
In the wake of opposition from participating specialty physicians and reports of problems with similar systems around the country, Highmark Blue Cross and Blue Shield says it will wait until early 2001 to implement changes in the way it pays three types of specialty physicians for treating its Medicare HMO members.