It's always nice to see that there's light at the other end of the pay for performance tunnel, namely, a big fat pile of cash. In this case, a group of seven California health plans has paid big bonuses to high performers on their roster, which includes 35,000 physicians working in 210 medical practices. This year's $55 million payout, as in previous years, went to physician groups who performed best on clinical care, patient satisfaction and smart use of IT during 2005. Among the most tangible improvements they made were in preventive care. The groups reported screening about 60,000 more women for cervical cancer, testing 12,000 more diabetics and administering about 30,000 more childhood immunizations than they had in previous years.
In theory, all of the medical groups had a level playing field here. Rather than establish competing measures, the health plans are largely working under a common P4P program developed by the state's Integrated Healthcare Association (IHA). Participating plans include Aetna, Blue Cross of California, Blue Shield of California, CIGNA, Health Net of California, PacifiCare and Western Health Advantage. Still, these plans kick in some extra bucks to medical groups who meet additional criteria specific to that insurer, rewarding them with an additional, much larger, payment of $89.5 million in 2006. Given the larger size of this plan-specific bonus pot, it does appear that the "centralized standards" thing needs some work.
To learn more about the program:
- read the IHA's press release on the P4P payout
- read this report on how the health plans determine payout levels
ALSO: The IHA announced this week that it would add efficiency measures to the next-gen report card it will use to make its next round of P4P payments. Release