Navigation Links
New Health Plan Payment Models Are Improving Patient Quality and Safety

Private-Sector Solutions Essential for Sustainable Health Care Reform

WASHINGTON, April 28 /PRNewswire-USNewswire/ -- Private-sector strategies to improve health care quality and value are an essential component of comprehensive health care reform, according to America's Health Insurance Plans (AHIP). AHIP hosted a press conference today to highlight the innovative payment models health plans have implemented to reward quality and spur improvement.

"There is widespread agreement that delivery system reforms are needed to improve patient care and make health care more affordable," said Karen Ignagni, President and CEO of AHIP. "Health plans are pioneering the types of innovative approaches necessary to move to a 21st century, evidence-based health care system."

AHIP released a new publication, Innovations in Recognizing and Rewarding Quality, showing measurable results from health plan payment models that are reducing costs, enhancing quality, and improving patient satisfaction. The report highlights some of the most innovative approaches that plans have taken to recognize and reward physicians and hospitals for achieving national benchmarks, demonstrating outstanding performance, and making measureable improvements over time.

"As our nation struggles with rising health care costs, health plans are piloting new payment models that are making the system more affordable and improving value and quality," said Lewis Sandy, MD, Senior Vice President of Clinical Advancement at UnitedHealth Group.

A 2006 New England Journal of Medicine article reported that at least half of the nation's health plans, representing 80 percent of enrollees in such plans, included some pay-for-performance incentives in their provider contracts. Physicians and hospitals are evaluated on a variety of measures, including clinical quality, patient satisfaction, utilization of services, and business practices. These payment models have been developed in close collaboration with participating physicians and other stakeholders.

"Rather than simply being reimbursed for the volume of care provided, physicians and hospitals should be rewarded for intervening early, managing care efficiently and improving health outcomes," said Roberta Herman, MD, Chief Medical Officer and Senior Vice President at Harvard Pilgrim Health Care.

The new AHIP publication highlights measureable results that health plan pay-for-performance programs have achieved, including:

  • Better adherence to evidence-based treatment guidelines for patients with chronic conditions, such as diabetes, asthma, and coronary artery disease
  • More patients getting recommended treatment following hospitalization
  • Reduction in emergency room visits
  • Increased generic prescribing rate
  • Greater adoption of new technologies, such as electronic medical records, e-prescribing, and patient registries
  • Increased adherence to recommended preventive screenings and vaccinations
  • Enhanced patient satisfaction

"There is still wide variation across the country in how physicians practice and what care they give, and, as a result, research shows that Americans continue to spend significant health care resources on inappropriate and unnecessary care," said Steven Udvarhelyi, MD, Senior Vice President and Chief Medical Officer at Independence Blue Cross, noting that poor performance in our health care system costs the nation up to 79,000 avoidable deaths, 66.5 million sick days, and $1.8 billion in excess medical costs each year.

Health plans typically use nationally recognized performance measures to evaluate physicians, including the Healthcare Effectiveness Data and Information Set (HEDIS), which was developed by the National Committee for Quality Assurance (NCQA). Many health plans also participate in Bridges to Excellence, which incorporates NCQA's Physician Recognition Program into its pay-for-performance approach.

To evaluate hospital performance, health plans use a variety of public and private sources, including The Leapfrog Hospital Rewards Program, CMS's Hospital Compare measures, and quality measures developed by the Agency for Health Care Research and Quality (AHRQ).

The new AHIP report is a follow-up to previous publications that highlight innovative approaches to reforming the health care delivery system in the areas of chronic care, prevention and wellness, and health information technology. These reports provide valuable information on the types of reforms that are working to improve quality, enhance patient safety, encourage greater adherence to prescribed treatments, spur investments in health information technology, and improve the overall patient experience.

As Congress considers various proposals to reform the health care system, AHIP is encouraging policymakers to consider the next generation of delivery system reforms that are currently underway in the private market and that have yet to take hold in public programs.

The full publication, Innovations in Recognizing and Rewarding Quality, is available here:

Read the AHIP Board of Director's statement on delivery system reforms here:|44|26308.

Visit to learn more about the value health plans provide to the current health care system.

America's Health Insurance Plans - Providing Health Benefits to More Than 200 Million Americans

SOURCE America's Health Insurance Plans
Copyright©2009 PR Newswire.
All rights reserved

Related medicine news :

1. Penn study finds pro-death proteins required to regulate healthy immune function
2. UCLA researchers identify markers that may predict diabetes in still-healthy people
3. Air pollution linked to cardiovascular risk indices in healthy young adults
4. More proof needed of safety and quality of electronic personal health records
5. Health care incentive model offers collaborative approach
6. Loneliness is bad for your health
7. Mailman School of Public Health study examines link between racial discrimination and substance use
8. Green Tea May Brew Up Healthier Skin
9. For Health Info, Women Often Turn to the Web
10. Record Number of Americans Lack Health Insurance
11. U.S. Research Funding Continues to Flatten as U.S. Health Costs Climb - in August 31 Science
Post Your Comments:
(Date:11/27/2015)... , ... November 27, 2015 , ... ... the well-respected Microsoft Dynamics SL User Group (MSDSLUG). Recognized as Microsoft’s official group ... group of Microsoft Dynamics SL software users, partners, industry experts and representatives. Intellitec ...
(Date:11/27/2015)... ... November 27, 2015 , ... Keeping in mind ... mental health and wellness consultation, has collaborated with a leading web-based marketplace for ... gap experienced by parents and bring advice from parenting experts within their reach. ...
(Date:11/27/2015)... ... November 27, 2015 , ... Dr. Thomas Dunlap and ... Dr. Tucker Bierbaum with Emergency Medicine at St., Joseph Health System’s Santa Rosa ... Sepsis conditions present in similar ways and require time-critical intervention to avoid large area ...
(Date:11/26/2015)... ... November 26, 2015 , ... Patients at Serenity ... have come together on Thanksgiving Day to share the things that they are ... the Serenity Point YouTube channel, patients displayed what they wrote on index cards, ...
(Date:11/26/2015)... VA (PRWEB) , ... November 26, 2015 , ... ... an American Express Travel Representative. As a franchise owner, Somu now offers travelers, ... of cruise, destination wedding packages, private cruise sales, as well as, cabin upgrades ...
Breaking Medicine News(10 mins):
(Date:11/26/2015)... DUBLIN , November 26, 2015 /PRNewswire/ ... the addition of the "2016 Future ... Drugs of Abuse Testing Market: Supplier Shares, ... report to their offering. --> ... of the "2016 Future Horizons and ...
(Date:11/26/2015)... STOCKHOLM , November 26, 2015 /PRNewswire/ ... --> Juntendo universitetssjukhus ser potential att ... av magnetresonansbilder (MR-bilder) för patienter med ... tecknat ett forskningsavtal med SyntheticMR AB för ... kliniska forskningsprojekt på sjukhuset. Med SyMRI kan ...
(Date:11/26/2015)... , November 26, 2015 /PRNewswire/ ... --> adds "Global ... and "Investigation Report on China Repaglinide ... 2021 forecasts data and information to ... . --> ...
Breaking Medicine Technology: