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New Health Plan Payment Models Are Improving Patient Quality and Safety
Date:4/28/2009

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: http://www.ahip.org/content/default.aspx?docid=26393.

Read the AHIP Board of Director's statement on delivery system reforms here: http://www.ahip.org/content/default.aspx?bc=31|44|26308.

Visit www.ahip.org/value 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


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SOURCE America's Health Insurance Plans
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