Momentum is building to use physician reimbursement and bonuses not just as utilization controls, but as quality-improvement tools.
Harvard Pilgrim Health Care and Partners Health Care have settled on a four-year contract that ties reimbursement to quality-of-care goals. Two standards mimic HEDIS guidelines: Partners' physicians must test adult diabetes patients annually for HbA1c and LDL-C levels, diabetic retinopathy, and nephropathy, and are required to put children with asthma on antiinflammatory medication. In addition, physicians are asked to prescribe generic drugs over brand-name products when possible. The HMO will use withholds to drive its demands, refunding money to providers who meet these standards.
L.A. Care, a Medicaid HMO, has taken a different approach, giving straight bonuses to physicians who document thorough primary care. It has paid $600,000 in bonuses this year and the data it collected from providers about primary care has improved noticeably. L.A. Care hopes the information eventually can help efforts to develop risk profiles and improve health outcomes.
In July, Blue Cross of California began to pay bonuses to doctors who met quality targets.