BCBSTX has been a leader in providing information to consumers on physician performance on evidence based measures guidelines and relative cost of care.  As the market has matured, several organizations such as the National Committee for Quality Assurance (NCQA) and the National Quality Forum (NQF) are beginning to develop national standards for reporting of physician performance and we support these efforts.  Thus, we elected to discontinue the affordability scale (our physician and professional provider relative cost of care indicator) and the use of the risk adjusted cost index (RACI) to determine eligibility for the BlueChoice® Solutions High Performance Network until the national standards are more clear and we assess our alternatives.

Q1.  Why did BCBSTX decide to discontinue the use of the RACI? 

A1.  BCBSTX created the Risk Adjusted Cost Index methodology in 2003 and continually worked to further develop and enhance it.  We received recognition for this innovative mechanism to evaluate affordability.  Since the development of the RACI, there has been significant change in this arena. Several organizations such as the National Committee for Quality Assurance (NCQA) and the National Quality Forum (NQF) are beginning to develop national standards for reporting of physician performance and we support these efforts.  At this time, we have chosen to discontinue the affordability scale and the use of RACI to determine eligibility for the BlueChoice Solutions network until we can assess and create a new methodology. 

          
Q2.  I thought that BCBSTX was only going to remove BlueCompare Affordability scales and not use RACI to remove providers from the BlueChoice Solutions network.  Why is BCBSTX also not allowing newly eligible providers to be added to the BlueChoice Solutions network?

A2. For the reasons stated above, there will be no RACI evaluation performed in 2008 to determine eligibility for the 2009 BlueChoice Solutions network.  This means there will be no removals or additions to the 2008 and 2009 BlueChoice Solutions networks based on a RACI score.  The current BlueChoice Solutions network meets our customers’ needs; therefore, changes to the network composition are not warranted at this time.

NOTE:  We will continue to add the following providers to the BlueChoice Solutions 2008 and 2009 networks:  providers that join an existing BlueChoice Solutions group and providers that practice in a specialty that was not modeled. Of course, we will continue to have normal disruption from BlueChoice network activity.  For example, if a physician or professional provider cancels their BlueChoice contract, then they will also be removed from BlueChoice Solutions.