The 2022 Blue Cross Blue Shield “procedure and vaccine incentive” criteria for bonuses for primary care providers

https://www.bluecrossnc.com/providers/blue-medicare-providers/policies-and-responsibilities

I came across this provider incentive program from 2022, for Blue Cross Blue Shield of North Carolina. **please note, they stopped listing how much money the provider makes for each billing code. That is kept “secret” via the provider portal, they log in to keep track of their quality points to make sure they are on track for bonus,**

First up:  “quality management”.  AKA procedures and documentation we mandate you do, under certain codes, to earn your bonus each year.

https://www.bluecrossnc.com/sites/default/files/document/attachment/providers/public/pdfs/Full_Measures_List_11012017.pdf

They have expanded their “quality management” from the 2016 document we looked at yesterday.  Some of the new goals that providers are supposed to meet are very curious:

Not prescribing antibiotics for acute bronchitis

Initiation of ADHD meds in children

Initiation of and long term antidepressant use

Cervical cancer screenings

Chlamydia screening in women age 16-24

The combo 7/combo 10 vaccine schedule for kids age 0-2

Colonoscopies

Getting patients into treatment for drug/alcohol abuse

Getting the HPV and meningococcal vaccine into teens

Early use of X-ray/CT scan/MRI for lower back pain patients

Osteoporosis medication for women

Statin therapy for anyone with diabetes/heart disease

Ensuring 80% patient compliance with statin meds

Ensuring 6+ “well child” visits from birth to 15 months

Ensuring patients with diabetes are all on continuous statins

WOWWWWW.  Some notables stick out there……the constant pushing of statins, the pushing of the HPV vaccine in teens, starting psych meds and ensuring they stay ON THEM, the ever popular Fosamax osteoporosis med pushing.  They have become more aggressive in 2022 compared to the 2016 report we looked at yesterday. There are numerous additions to the “bonus program” compared to 2016.

They even make a handy pocket guide for the provider to ensure they meet all the goals! https://www.bluecrossnc.com/sites/default/files/document/attachment/providers/public/pdfs/pqn_pocket_guide.pdf

For every single one of these diagnoses above, there is a handy “pocket guide” that tells the provider what must be done, what must be charted, and what ICD codes to send to the insurance company to “be in compliance” and earn their bonus. I have screenshot some examples below. You can see all of them in the link above to the pocket guide.

Notice how they even list what “product line” (type of insurance) this applies to?  They want every single patient who has commercial employer insurance, marketplace private insurance, and state funded Medicaid for this population target are!  They even offer bonus structures for providers who have parents opt out of a flu vaccine but get all of the others.  And notice who they report your kids vaccination status to:  the insurance company AND the state vaccine registry! They even note what types of vaccine reactions exclude the patient and provider from having it “count against them”.

Ohhhhhh this is the fun addition of you must be strep tested to get an antibiotic for tonsillitis.  More $$$ to do that rapid strep test!

This is targeting teens for meningococcal and HPV vaccines.  Notice who they report this data to as well………

Statins!!!  Prescribing them isn’t enough, they want PHARMACY RECORDS TO ENSURE 80% COMPLIANCE by filling that RX for at least 180 days!  Sweet baby Jesus.  🤦🏼‍♀️

Here is the fun little portion that discusses how to ensure the provider meets the financial goals: https://www.bluecrossnc.com/sites/default/files/document/attachment/providers/public/pdfs/provider_toolkit_2020.pdf

And have a little lookie loo at their covid vaccine policies and the propaganda they use to sell the boosters.  https://www.bluecrossnc.com/covid-19/covid-19-vaccine-information

This one from 2022 does not give a monetary amount like the 2016 one did.  The provider has to log into their account to see the $$ they will get as well as see if they are on target to make their bonuses based on current ICD 10 codes sent to the insurance company. They stopped making that public information like they did back in 2016. Gee, I wonder why……..