MANAGED CARE April 2003. ©MediMedia USA
In a effort that will be watched by health plans and physician associations nationwide, Premera Blue Cross of Washington puts doctors into tiers according to how well they help control costs. Physicians considered most efficient are placed in the
lower-cost tier. The Washington State Medical Association's reaction is that tiering doesn't make sense without outcomes measurement. Jeffrey Collins, MD, the president-elect of the physician organization, says that using cost data alone could be hazardous.
"I know the health plan thinks it can figure it out with a data system," Collins tells AMNews. "But if you have someone who is really ill, there may be no relationship between the cost of care and the quality of care."
This unease exists despite Premera's promise to adjust the measurements for case mix and severity in a way that should prevent physician groups with many patients that have more costly problems from being penalized.
The system, called Dimensions, tracks costs at large clinics, representing about 15 percent of doctors in the Premera system.
Paul Ginsburg, director of the Center for Studying Health System Change, tells AMNews that he sees "only positives" coming out of such a move — such as lower premium costs for patients who can't currently buy insurance.
"If the groups that did poorly [in the profiling] look at why and try to change it, that would have a much greater impact on costs," he says.
Last year, Premera discussed preliminary cost analyses with medical group executives, giving them a chance to object to tier assignments. Dimensions was begun as a pilot last June, and Premera hopes to eventually roll it out to all of its customers.