Coalition of Health Plans To Pay $50 Million in Quality Bonuses to 215 Physician Groups
A coalition of six health plans on Thursday announced they will pay $50 million in bonuses to 215 doctors' groups in the state that received positive evaluations for immunizing children, screening women for cancer and other care under a "pay-for-performance" program, the AP/Riverside Press-Enterprise reports. Integrated Healthcare Association sponsored the program, which involved about 45,000 doctors in 215 medical groups, or about 66% of physician groups in the state. The association includes Aetna, Blue Cross of California, Blue Shield of California, CIGNA, Health Net and PacifiCare Health Systems.
The doctors' performance was evaluated based on claims submitted to health plans or on data provided by the doctors' groups themselves. Factors for evaluation included clinical quality, patient experience and efficiency measures such as adopting electronic health records. Much of the scoring involved offering preventive care and services (Jablon, AP/Riverside Press-Enterprise, 10/21).
Nearly 150,000 more women received cancer screenings in 2003 than in 2002. In addition, 35,000 more women were screened for breast cancer; 10,000 more children received two necessary vaccinations; and 18,000 more people were tested for diabetes (Wolfson, Orange County Register, 10/22). There was wide variation in clinical quality issues such as cancer screenings, with 74 groups scoring "significantly higher" than others in those areas, the AP/Press-Enterprise reports.
However, measurements of patient experience -- such as how long it takes to be seen by a doctor -- did not vary widely, according to Steve Shortell, dean of the School of Public Health at the University of California-Berkeley. In addition, Shortell said that physician groups in Northern California scored better on patient experience than those in Southern California but added that the reason is not clear.
California Association of Physician Groups CEO Don Crane said the current system for reimbursing doctors is "good quality, bad quality, same payments. Henceforth, the higher performers are going to get paid for their quality."
Shortell said, "In the short run, we will not see much influence of consumers moving to other plans based on the public report card. The bigger impact is going to be on the physician organizations themselves" (AP/Riverside Press- Enterprise, 10/21).