Blue Cross of Mass. to Boost Payments to Independent Primary Care Practices

Last week, Healthcare Innovation reported on a bill in the Massachusetts Legislature that would establish an aggregate primary care expenditure target for the Commonwealth, as well as an opt-in prospective payment model for primary care physicians. Also responding to the urgent need to bolster primary care in the Bay State, Blue Cross Blue Shield of Massachusetts announced it will increase reimbursement rates to qualifying small, independent primary care practices.

Blue Cross noted that the announcement comes at a critical time, as the percentage of Massachusetts patients who report being able to see their doctor when needed fell to a record low in 2023.

“Primary care practices deserve our praise and gratitude. They have risen above enormous obstacles in the past few years to deliver improved patient experiences for patients. This is remarkable,” says Massachusetts Health Quality Partners (MHQP) CEO and President Barbra Rabson, in a statement. “However, access to primary care is getting significantly worse and is contributing to emergency room backups and other system imbalances. At the same time, the percentage of total medical expense supporting primary care in Massachusetts is declining. This crisis needs immediate attention.”

MHQP is an independent, nonprofit measurement and reporting organization that brings together key stakeholder groups (providers, payers and patients) in Massachusetts healthcare to help provider organizations, health plans and policy makers improve the quality of patient care experiences throughout the state.

As part of its new initiative, eligible primary care practices in Blue Cross' network will start receiving increases in their reimbursements — as much as 30 percent. The funding will assist small independent primary care practices and is not expected to increase members' total costs. 
"We need to support our primary care clinicians now more than ever before," said Sarah Iselin , president and CEO of Blue Cross, in a statement. "We are committed to doing our part to sustain and strengthen primary care in the Commonwealth to help ensure everyone can access the care they need, when they need it most." 

Over 1,000 primary care providers, including nurse practitioners and physician assistants, will be eligible for the increases. Up to $20 million in new funding will be distributed to eligible practices amid state's primary care crisis. This investment builds on Blue Cross' efforts in value-based payment models, the organization said. 

"Investing in primary care should start where it is needed most – with small, independent practices," said Mark Friedberg , M.D., senior vice president, performance measurement & improvement at Blue Cross, in a statement. "These practices provide high-value services for our members, and we need to do what we can to support them during this critical time. We also know that strengthening primary care helps improve outcomes and overall healthcare affordability.”

Blue Cross said it has grown its primary care network by 10 percent over the past five years, with 93 percent of its primary care network reporting having openings within 45 days for routine or preventive care visits. Some of Blue Cross' newer primary care groups include Eden Health and On Belay Health Solutions.