Study Affirms Benchmark Use

Medical homes and accountable care organizations have a much greater chance of succeeding if physician pay is tied to performance, according to what is described as the first large-scale study of commercially insured patients to look into the matter.

“Although there is a good deal of evidence about variability in costs under Medicare, little has been published about the variability of costs for care that is financed by private insurance,” says a study in the September issue of Health Affairs, “Wide Variation in Episode Costs Within a Commercially Insured Population Highlights Potential to Improve the Efficiency of Care.”

That’s not all that it highlights. Doctors who meet quality and efficiency benchmarks provide care at costs that are 14 percent lower than costs for other doctors in the assessment program.

The study ( looks at 250,000 doctors who contract with UnitedHealthcare. It covers 21 different disciplines — including primary care, cardiology, and orthopedics — that account for more than 60 percent of the insurer’s employer-sponsored business. The analysis, for the most part, reflects care delivered in 2007 and 2008.

“For that period, 43 percent of the evaluated physicians received both the quality and cost-efficiency designations, and 14 percent received the quality designation only.” There were other categories as well, but the main point is that the doctors given quality and cost-efficiency benchmarks saved the plan money.

“Those distinctions in performance translate into meaningful differences in the care that patients receive. For example, cardiologists implanting arterial stents who have a quality designation had 55 percent fewer redo procedures — that is, stent replacements — and a 55 percent lower complication rate for those procedures than other cardiologists.”

The authors say the findings could influence “a wide range of payment reform initiatives, including primary care medical homes seeking to coordinate their patients’ care more effectively and receive bonuses tied to their quality and efficiency; accountable care organizations that take an additional responsibility for the quality and total costs of care and for population health; and, obviously, episode-based payment approaches.”