In what is being billed as likely the first large-scale analysis of privately insured patients, a new report from UnitedHealth Group finds that high-quality care was more affordable on average compared with care that had no tie to quality and performance incentives.
The report, published in the special September issue of Health Affairs, focuses on payment reform and healthcare delivery. Titled “Wide Variation in Episode Costs Within a Commercially Insured Population Highlights Potential to Improve the Efficiency of Care,” it evaluates care quality and medical costs for episodes of care by reviewing data from nearly 250,000 U.S. physicians serving commercially insured patients nationwide. That is a departure from previous research that has focused largely on Medicare patients.
This group of patients represent people who have employer-sponsored health insurance and those who have purchased individual health coverage. The results are based on data from the UnitedHealth Premium Physician Designation Program, in which nearly 250,000 U.S. physicians participate spanning 41 states and covering 21 different medical specialties — including primary care, cardiology and orthopedics. These procedures together make up more than 60 percent of the medical spending covered by UnitedHealthcare’s employer plans.
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Specifically, the study found that when care was tied to quality and performance incentives — in other words when the physicians garnered both quality and cost-efficiency designations, the episode costs on average were about 14 percent lower than costs for other physicians across all of the specialties included in the assessment program.
“This research shows that for families across the nation, high-quality care can indeed be more affordable care,” said Simon Stevens, chairman of the UnitedHealth Center for Health Reform & Modernization, executive vice president of UnitedHealth Group and one of the report’s co-authors, in a news release. “But these results underline the urgent need for effective new payment incentives, combined with appropriate support for dedicated care professionals, if the country is to capitalize on the scale of the improvement opportunity this research reveals.”
There was also significant variation in costs for a group of major medical procedures — two-and-a-half times — while those for common chronic conditions varied 15-fold nationwide.
The common chronic conditions include asthma and diabetes, among others while the medical procedures that were reviewed include cardiac catheterization.
Other recommendations from the report, from the news release are:
- Continue improving the sophistication of quality measures. The authors advise that leading health-related organizations “need to continue expanding the scope of evidence-based and physician-endorsed measures including patient-reported outcome measures to help capture changes in patients’ health.”
- Expand and share data to encourage more granular performance analysis.
- Help doctors and hospitals by providing tools and other support, not just new incentives. “History has shown that simply promulgating new performance-based payment incentives will not by itself ensure that care improves,” the article states. “To succeed under new payment arrangements, hospitals and physicians will need to have in place strong governance mechanisms; effective financial systems … and a robust set of clinical programs that they can employ to help manage their patients’ care and support patients in managing their own health.”
The report also called for a broader approach to payment reform as opposed to a one-size-fits-all model. That comes with the recognition that providers are at different stages of moving from a fee-for-service model to a value model.
However, there is no turning the clock back.
“Most doctors and hospitals should be ready to adopt ‘performance-based contracting,’ which largely maintains existing payment methods but ties payment increases to performance on specific measures of quality and efficiency such as readmission rates or prescribing rates for generic drugs.”
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