BLOOMINGTON, Minn.–HealthPartners, the country’s largest insurance cooperative, said Tuesday that it paid out $370,000 in performance bonuses to doctors, a significant drop from the previous year.
Judging from HealthPartners’ annual pay-for-performance figures, Americans seem to have received considerably less quality care based on goals the company set in 2008. While the company’s overall pool of incentive pay rose nearly 19 percent to $24.9 million, its Partners in Excellence program, performance bonuses given to primary care and specialty groups, doled out 45 percent less money this year than last year, when it paid out $670,000.
Over the past few years, insurers across the country have been adopting pay-for-performance programs to nudge doctors, pharmacists, clinics and hospitals away from the volume-based payment system that experts say lie at the heart of a bloated, inefficient health care system in the United States.
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Instead of paying providers for the number of patients they see, surgeries performed, or medications prescribed, insurers hope to better link payments with quality and cost metrics like improved medical outcomes, use of generic drugs and adoption of electronic medical records. Minnesota payers like UnitedHealth Group, Blue Cross Blue Shield, and UCare all offer such incentive programs.
UCare said last month that it paid out $2.4 million to providers last year, a 58 percent jump over 2007. Unlike most pay-for-performance programs, the nonprofit group rewards providers that make any improvement in quality scores.
HealthPartners was one of the first payers in the country to offer a pay-for-performance program. Partners for Quality, which debuted in 1997, consist of two parts: Partners in Excellence, which targets areas like cardiology, women’s health, ear, nose and throat, physical therapy and behavioral health; and Partners in Progress, payments built into specific provider contracts for primary care, specialty, hospital, retail pharmacies and physical therapy practices. The lion’s share of HealthPartners incentive money goes to the latter.
The company measures and scores performance based on factors like a patient’s blood pressure, body mass index, cholesterol levels and alcohol and tobacco use. The program also surveys patient satisfaction and determines whether doctors devoted more than 72 percent of all their prescriptions to cheaper generics.
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But such programs have received mixed reviews. For one thing, insurers use such varying systems of metrics that makes comparisons difficult, if not impossible. Also, the amount of money payers offer are too low to really impact providers’ behavior, according to a report by PricewaterhouseCoopers’ Health Research Institute.
According to the study, insurers pay out anywhere from 1 percent to 8 percent of total base physician reimbursement, whether in bonuses or fee schedule increases.
“While the magnitude of the payment is obviously affected by the patient volume involved, some payers noted that they thought it would take at least a 1o percent reward to affect physician clinical behavior,” the report said, “but noted that they could not secure the necessary commitment from the health plan’s leadership to fund the programs at that level.”
In HealthPartners’ case, a lot fewer doctors in 2008 qualified for the relatively limited amount of incentive money the payer does offer. Which begs the question: Did HealthPartners-affiliated doctors perform that badly that year, or does HealthPartners need to boost its pool of incentive cash?