An Action Research Project

“BCBSMA ... respects the privacy of the therapeutic setting“

May 1, 2007 letter to therapists from BCBSMA:

 

On May 1, 2007, Blue Cross Blue Shield of Massachusetts (BCBSMA*) will launch an outcomes measurement program in conjunction with our designated vendor, Behavioral Health Laboratories, Inc. (BHL), using their Treatment Outcome Package (TOP). To help you learn more about this program, this F.Y.I. addresses privacy/confidentiality, our fee schedule revisions, and training.

Privacy/Confidentiality Issues

Ensuring member privacy is a top priority at BCBSMA. To this end:

· BCBSMA will not receive identified member responses to the specific instrument questions or the associated domain scores.

· BCBSMA will not utilize the responses or domain scores for utilization management purposes.

· BCBSMA will receive:

o Notice that a specific member has completed an instrument. This information will be used to process automated authorizations (see below) and to determine the Provider Participation rate.

o A member-identifiable score between 1 and 5 indicating the likelihood that the member would benefit from case management. Providers will be contacted before BCBSMA offers case management services to their patients.

Periodic de-identified instrument scores to determine the impact of the outcomes program on behavioral health and medical utilization. BCBSMA will form an Outcomes Scientific Advisory Council consisting of representatives of professional societies and academic experts to assist us in reviewing this and other outcomes-related data.

BCBSMA understands and respects the privacy of the therapeutic setting and has taken these significant steps to protect the privacy of our members. Member participation in this program is voluntary, and members may choose not to answer some or all of the questions on the TOP.

Overview of Fee Schedule Updates for 2008 and 2009

As we noted in our November 1, 2006 communication, future fee schedule revisions for outpatient services will be linked to participation in the outcomes measurement system. This is explained in more detail on pages 5-6, including the defined terms used in this F.Y.I. To summarize, providers who participate in the Outcomes Program will be paid according to a higher fee schedule than providers who choose not to participate:

· For the January 1, 2008 fee update, providers who registered with BHL before August 1, 2007 will be paid according to higher fee schedules than providers who had not registered with BHL.

· For the January 1, 2009 fee update, providers who have achieved their Participation Rate targets with Qualifying Members will be paid according to higher fee schedules than those who do not achieve the targets.

 

From https://www.bluecrossma.com/ website for providers