New Health Plan Payment Models Are Improving Patient Quality ...(of services and business practices. The...),Health

"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
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