San Diego Union Tribune
In a move aimed at improved health, six of the largest managed-care plans in California will award bonuses to doctors groups based on the quality of care they give their patients.
While individual plans have taken similar steps, the initiative by the six health plans, which collectively cover one-third of the state’s insured population, “is the first statewide multi-plan effort of its kind in the country,” said Beau Carter, executive director of the Integrated Healthcare Association, an HMO trade association based in Walnut Creek that is spearheading the move.
The initiative potentially could affect 35,000 doctors and 8 million patients in the state who contract with and are members of commercial managed-care plans. Enrollees of Medicare and Medi- Cal health-maintenance organizations are unaffected.
The participating plans are Aetna, Blue Shield of California, Blue Cross of California, Health Net, PacifiCare Health Systems and Cigna. In essence, the plans have agreed to use the same criteria to compare the performance of medical groups in patient care and to reward the groups based on their results.
Those criteria include three preventive measures including childhood immunizations and cancer screenings, three chronic-care measures including asthma and diabetes care, patient satisfaction measures and investments made in technology and infrastructure.
Each plan will determine how much it will reward the doctors groups.
While many details are being worked out, officials at a news conference in San Francisco estimated the health plans will eventually commit about $100 million annually to the effort.
They said the bonuses are in addition to monthly payments made to doctors groups by health plans, but it is unclear how much of the bonuses will be new money and how much a reallocation of funds already being paid to doctors groups.
One consumer advocate immediately took aim at the initiative, calling it “illusory” and saying it does nothing to solve the fundamental problem of California’s health-care system.
“A small bonus paid by HMOs to physicians for quality indicators will not negate the fact that 100 percent of physician pay outside of the bonus is still based on the premise of paying doctors more money for providing less medical services to patients,” said Jamie Court, executive director of the Foundation for Taxpayer and Consumer Rights.
Dr. Theodore M. Mazer, a San Diego eye, ear and throat specialist, said bonuses are an “insinuation that proper care isn’t being given right now, which is objectionable to doctors.”
He said increasing the monthly rates paid to doctors groups by health plans would be a better way of ensuring that doctors provide the highest quality of care.
The initiative comes at a crucial time, when medical costs are rising even as the quality of care is being questioned.
This year, employers are facing 12 percent to 15 percent increases in monthly health-care premiums, and employers in turn are seeking improvements in the quality of care.
“This initiative is not trying to get its arms around the entire health- care system and price trend,” said Peter Lee, president of the Pacific Business Group on Health, a purchasing coalition of more than 40 large and small employers in the state.
“What it is about, though,” he said, “is that knowing that employers are going to be paying more and consumers are going to be paying more, how can we make sure that some of that increase is specifically being targeted to reward better performance and to support re-engineering.”
While other initiatives also measure the quality of health care, many experts said doing so is an inexact science.
Dr. Jack Lewin, chief executive of the California Medical Association, said yesterday’s announcement is a step toward improving patient care. But he cautioned that doctors caring for the sickest patients could stand to be penalized because their outcomes will be worse than those of doctors caring for healthy patients.
“We are going to be wary and skeptical until (they) can demonstrate that they really are rewarding quality,” he said.