Posts exaggerate insurance incentives for child vaccinations

CLAIM: Blue Cross Blue Shield pays doctors a $40,000 bonus for administering childhood immunizations to at least 100 patients under 2 years old and an $80,000 bonus for vaccinating 200 children.

AP’S ASSESSMENT: False. Blue Cross Blue Shield Association is a national federation of more than three dozen locally operated companies, and doesn’t offer such an incentive across the board, the group confirmed. Every company can set its own performance-based incentives, and while vaccinations may be one category, that wouldn’t be the only measure taken into account, multiple experts agreed. The numbers being cited were incorrectly estimated based on data included in a 2016 incentive program for a Michigan Blue Cross Blue Shield plan, and actual payouts that year were well under $40,000.

THE FACTS: Social media users are recirculating a myth that’s been spreading online for years that the insurance group Blue Cross Blue Shield is using a hefty monetary incentive to entice doctors into administering as many childhood vaccinations as possible.

“In case you missed it, Blue Cross Blue Shield pays their pediatricians a $40,000 bonus if they have 100 patients under the age of two fully vaxxed,” one conservative social media personality said in an Instagram video that received nearly 19,000 likes. “But they’ll lose the entire bonus unless 63% of them are fully vaccinated, and that includes the flu.”

Other posts also claimed this incentive doubles as patient volume increases, paying up to an $80,000 bonus for vaccinating 200 kids, while also tying it to COVID-19 vaccines to suggest that these incentives are being leveraged to push COVID-19 vaccinations based on volume and profit alone.

The users do not offer any evidence for their claims. However, the same numbers were cited in a 2016 blog post titled: “How Much Money Do Pediatricians Really Make From Vaccines?”

The document that blog post referred to was a 2016 edition of a Performance Recognition Program specifically for the Blue Cross Blue Shield Blue Care Network of Michigan. In a table titled “Quality Incentive Measures,” the program lays out that doctors who meet 63% of their plan goal for childhood immunizations receive a $400 payout.

The blog then took these numbers and estimated that “the average American pediatrician has 1,546 patients,” though it gave no source for that information. It then used that figure to suggest that “if your pediatrician has just 100 fully-vaccinated patients turning 2 this year, that’s $40,000,” and “if your doctor manages to fully vaccinate 200 patients, that bonus jumps to $80,000.”

Blue Cross Blue Shield of Michigan said in a statement to The Associated Press that it “periodically provides financial incentives for physicians for administering the recommended vaccines for children under the age of two.”

In 2016, the payments per provider for its HMO’s incentive program ranged between $400 to $9,600, according to the Michigan group — well under the $40,000 to $80,000 range claimed.

Such incentives are common, said Thomas Buchmueller, a professor of risk management and insurance at the University of Michigan.

Different companies offer plans with varying incentives to physicians for performance targets, and employers can choose among a variety of plans, added Mark V. Pauly, a professor emeritus of Health Care Management at the University of Pennsylvania, who studies health insurance and medical economics. Vaccination percentages may be one such target, though it would be paired with other quality measures, he said. Incentives are usually tied to quality metrics such as patient satisfaction.

“I think a key point is that these incentives apply to vaccines that are widely understood to be very beneficial, which means that a greater vaccination rate indicates higher quality of care,” Buchmueller said.

Other incentives may be tied to practices such as promoting chlamydia screening due to negative side effects of infections that go undiagnosed, or checking young children for cavities, said Nadereh Pourat, a health policy and management professor in the UCLA Fielding School of Public Health.

“I can say in general that insurance companies or public payers have used both financial incentives and penalties to promote use of important preventive care in the past, but I don’t think the amounts are excessive or such incentives are long term,” Pourat said. “The hope is to get providers used to routinely providing evidence-based care but not to continue doing so forever.”

Blue Cross Blue Shield Association said in a statement to the AP that every Blue Cross Blue Shield company sets its own value-based contracts with local providers, and these vary from state to state, though vaccinations would not be the only measure to which an incentive is tied.

“The purpose of performance-based incentives, where they exist, is to reward implementation of well-established evidence-based best practices in the care of our members,” the association said. “While vaccinations may fall into that category, they would not be the sole performance measure. Any incentives cover a broad collection of best practices.”

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This is part of AP’s effort to address widely shared misinformation, including work with outside companies and organizations to add factual context to misleading content that is circulating online. Learn more about fact-checking at AP.