Calif. Health Providers Tout Insurer’s Pay-for-Performance Program
While some pay-for-performance initiatives across the U.S. are not meeting stakeholders' expectations, health care providers are touting a California initiative as a successful model, HealthyCal reports.
Details of Program
Not-for-profit health plan Central California Alliance for Health manages a pay-for-performance initiative -- called, "Care Based Incentive" -- that contracts with physicians in three counties:
- Monterey; and
- Santa Cruz.
The program offers health care providers significant financial incentives for meeting certain criteria, such as:
- Minimizing preventable hospitalizations and emergency department admissions;
- Extending office hours; and
- Submitting claims electronically.
Bonuses delivered through the program are based on a comparison of primary care providers. In addition, participating health organizations receive report cards each quarter that show which providers are performing better than others.
Caroline Kennedy -- medical director for the Monterey County Health Department Clinic Services Bureau -- said that the program is "intelligently designed," adding, "You have to be better than everyone else."
However, some physicians criticized the program for penalizing physicians for patient behavior that might be out of doctors' control.
One physician -- who asked not to be named -- said that doctors in his office do not receive incentive payments for treating their patients who tend to be sicker than other Alliance patients.He said, "A lot of this is beyond the control of the doctors on the front line" (Graebner, HealthyCal, 4/18). This is part of the California Healthline Daily Edition, a summary of health policy coverage from major news organizations. Sign up for an email subscription.