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Grand Junction-Based Rocky Mountain Health Plans Offers Case for Evidence-Based Care

Posted on: Monday, 6 March 2006, 03:01 CST

By Doehrman, Marylou

Rocky Mountain Health Plans is ahead of the game when it comes to a pay-for-performance system for physicians. RMHP is in the third year of a pilot program involving 1,900 people with diabetes and their physicians. Dr. David Herr, medical director, said doctors who redesign their office systems to meet the needs of chronically ill patients and achieve success with those patients as measured against a healthier population are financially rewarded for their efforts. Physicians who use patient registries and treatment plans based on accepted guidelines, emphasize patient self-management tools and are methodical about clinical outcomes for diabetes are supported and assisted by the health plan and given a dollar boost as well. The pool of incentive money is available through a withholding account that is part of the doctors' contract with Rocky Mountain, Herr said. Pay for performance allows you to align incentives to emphasize outcomes, he said. For example, physicians are rewarded according to how their patients' blood sugar level, cholesterol level and blood pressure compares to the general population. Herr said that when the program began, 25 percent of the diabetics participating had a blood pressure count that met the goal. Today, that value is up 34 percent, he said Herr said the pay-for- performance system could have a positive effect on the entire health care system. We are concentrating on diabetic care, where heart attacks, strokes and kidney failure are related, he said. We are seeing more and more people with diabetes - it involves 6 percent of the population. If people reach these goals, they are less likely to have the other problems - the savings would come through healthier people.Donna Marshall, executive director of the Colorado Business Group on Health, agrees that savings will eventually be born out of evidence-based medicine. We did a study on diabetes and found that not all of the plans were paying for diabetes education, she said. Although insurance companies may incur a bit more expense, Marshall said the payoff is in reduced health care costs and improved productivity. She said the number of diabetic-related hospital discharges in Colorado increased from more than 40,000 in 2000 to more than 50,000 four years later. The total charges went from just under $800 million to over $1.2 billion, she said. Lifestyle management reduces the risk of diabetes by 58 percent and for high- risk populations by 40 to 60 percent, Marshall said. We need to be robust in addressing wellness and prevention and best practices and actually looking for outcomes that tell us how well these conditions are being managed.

(Copyright 2006 Dolan Media Newswires)

Source: Colorado Springs Business Journal, The

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