HealthLeaders-InterStudy, a leading provider of managed care industry intelligence, reports that Massachusetts' Group Insurance Commission (GIC) has launched a new initiative that will tier physicians by an analysis of their cost efficiency and adherence to best practices. According to the latest issue of New England Health Plan Analysis, as of July 1, enrollees and their dependents who choose physicians and physician groups in higher-ranking tiers will be charged lower co-pays than those who choose physicians in lower-ranking tiers.
"The initial co-pay differential is small, $10 to $15," said Ric Gross, HealthLeaders-InterStudy analyst. "This should get enrollees and physicians used to the idea, without a lot of uproar. But it really is a significant increase in the influence health plans have over healthcare choices. If it's successful, I would expect to see health plans in other states picking this up."
The GIC began moving toward tiering cost and quality three years ago, when it required its health plans to submit all their claims to an outside vendor that analyzed the data for cost efficiency and adherence to best healthcare practices. These analyses were given back to the plans so they could identify quality, cost-effective hospitals, physicians and physician groups, based on certain measurements.
Participating health plans include Harvard Pilgrim Health Care, Tufts Health Plan, Fallon Community Health Plan, Neighborhood Health Plan, Health New England and UniCare, medical benefits administrator of the Commonwealth Indemnity Community Choice and Commonwealth Indemnity Plan Plus products. Tiering practices vary from plan to plan, with some tiering only specialists, while others tier primary-care physicians as well.
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