Pay-For-Performance Doctor Plan a Model
CINCINNATI — A program started in Ohio and Kentucky to give doctors financial incentives for improving patient care has become a model for similar pay-for-performance health care plans elsewhere.
Companies participating in the program, which began two years ago as a test in Cincinnati and Louisville, Ky., pay doctors extra money for meeting certain standards for care they provide for chronic illnesses. Doctors receive incentives ranging from $50 to $160 per patient annually through the Bridges to Excellence initiative, organizers say.
As of January, about 500 doctors in the pilot program that has expanded to Massachusetts and upstate New York had earned around $1 million in bonus payments across all segments of the program. The nonprofit coalition of doctors, employers and health plans that created the Bridges to Excellence initiative announced this week that the concept is in the process of moving into 10 states and involving more than 2 million people as employers and insurers take it into the wider marketplace.
"Bridges to Excellence is clearly a program that is getting attention and showing results," said Dr. Mark McClellan, administrator for the federal Centers for Medicare and Medicaid Services, which oversees Medicare and works with states to administer Medicaid health insurance.
The Bridges initiative helps companies by providing better preventive care for employees, reducing the risk of disease complications and helping lower overall costs of care for employers and insurers, organizers say.
McClellan wants Medicare to adopt a similar pay-for-performance plan, and considers the program started in Cincinnati one of the best models for how the government’s version of the incentives should work.
The program is focusing initially on care for diabetes and heart problems and on the adoption of improved information technology in doctors’ offices.
Some of the nation’s largest employers participate, including General Electric Co., Ford Motor Co, UPS, Verizon Communications Inc. and Procter & Gamble Co.
United Healthcare, Cigna Healthcare and CareFirst BlueCross BlueShield are three health insurers that also are involved in the initiative.
"We are looking to re-engineer delivery of care and to set some national standards on how we measure quality," said Jeff Hanson, president of the coalition and regional healthcare manager for Verizon.
The diabetes portion of the program costs employers about $175 per patient per month, including the bonuses and administrative costs, but the companies say they save about $350 per employee each month through reduced hospital visits, less unnecessary testing and other factors.
Doctors can receive an extra $100 per year for each diabetic patient and $160 for cardiovascular care.
"It’s a win-win situation, with patients getting better care and outcomes while the payer is saving money," said Dr. Jeffrey Kang, chief medical officer for Cigna.
The doctors are asked to meet existing standards set by the National Committee for Quality Assurance and the American Diabetes Association. To qualify for rewards, doctors must show that they work with patients with diabetes to control their blood pressure, blood sugar and cholesterol levels and regularly perform screenings such as checking kidney function.
"It provides a framework of care guidelines to help insure that nothing is overlooked or forgotten in the care of patients with diabetes," said Dr. Nolan Weinberg, a doctor of internal medicine in the participating Queen City Physicians group in Cincinnati. "And there is a reward at the end."
Aside from the pilot program’s four markets, some business coalitions are starting the incentives in Illinois, Colorado and Arkansas. Later this year, doctors in California and Utah also are expected to start receiving incentives through a collaboration involving the Bridges program and other private pay-for-performance initiatives.
Francois de Brantes, program leader with General Electric Corporate Health Care Initiatives, said GE got involved to increase the value that the company gets for the health care dollars it spends. The company is on track to reach its goals of having 20 percent of doctors meet the standards and 25 percent of employees see those physicians, he said.
Dr. Mary Frank, president of the American Academy of Family Physicians, said the Bridges to Excellence initiative is headed in the right direction, and her group is considering participating.
"My only concern is that we might jump into the first plan that comes along without making sure what will work best," Frank said.
The American Medical Association recently released guidelines – including the use of accurate data and voluntary participation by physicians – that it says should be applied to pay-for-performance plans.
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On the Net:
Bridges to Excellence: http://www.bridgestoexcellence.com