HealthLeaders-InterStudy, the leading provider of managed care market intelligence, reports that the nation's largest pay for performance program is breaking new ground with the addition of cost-efficiency measures and the development of a historic agreement that would allow health plans access to laboratory results exclusively held by physician groups. According to the latest California Health Plan Analysis, the state's physicians are generally supportive of the program; however, they believe the program, which is sponsored by the Integrated Healthcare Association in California, needs a significant boost in payment to see a return on investment.
"The data exchange, which would give physician groups additional information they're looking for from health plans, is seen as critical to getting insurers to put more money into the bonus payment program sponsored by the Integrated Healthcare Association," states Chris Lewis, market analyst for HealthLeaders-InterStudy and author of the report.
Since 2003, the Integrated Healthcare Association has paid out close to $207 million in bonuses to 40,000 doctors. Physician groups have been pressuring health plans to put up more money to sustain their long-term investment in the program, while health plans and purchasers have pushed to include cost efficiency measures in the pay for performance program. In addition, more outcomes measurements are being added to the program to not only track improvements in preventive screenings but also to determine whether members' health status is improving.
Beginning in 2008, the Integrated Healthcare Association is adding cost-efficiency measures for payment in 2009. Efficiency is a key component of healthcare quality improvement and that variations in the cost and effectiveness of care continue to escalate within the provider community. Physicians are split on the issue; with some saying efficiency metrics should have no part of a program that was designed to improve quality.
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