The Boston Globe reported recently that Blue Cross and Blue Shield of Massachusetts wants to stop paying doctors and hospitals simple FFS for most individual patient visits, and instead offer a flat sum per chronic disease patient each year, adjusted for age and sickness. Providers who improve care would also receive a significant bonus. Blue Cross expects patients could see dramatic changes, such as quicker access to the doctor, same-day appointments, home visits by nurses, and smoother transitions between hospital, rehabilitation center and home.

This system is designed to incentivize health care providers to work together to achieve higher quality, cost effective outcomes. That’s the good news. The not-so-good news, in ACC member Joe Drozda’s words: “If you simply impose the new reimbursement systems on providers who are organized to provide services under the old system, you are not likely to succeed. You can't force fit reimbursement methodologies.”  But, this is a fascinating development nonetheless, representing payment both for coordinating care and for higher quality. Payment reforms are a-coming — and are needed (think SGR). But we need to propose how this could happen fairly.