Bonuses for delivering high quality care will be the focus of a three-market program spearheaded by the National Committee for Quality Assurance and supported by a coalition of physicians, health plans, large employers, and the Centers for Medicare and Medicaid Services.

"Rewarding physicians for improving the quality of health care they give just makes sense," says CMS Administrator Tom Scully. "We applaud the efforts of all of the parties, public and private, who are responsible for launching this initiative."

The effort — called Bridges to Excellence — which was unveiled April 10, focuses on diabetes care in the Cincinnati and Louisville market, and on physician investment in information systems and care management tools in the Boston area.

"A lot of physicians would like to invest in information systems to help deliver better care, but insurance payments haven't covered those costs," says Thomas Lee, MD, the medical director of Partners Community Health Care in Boston.

In the diabetes program, called Diabetes Care Link, physicians will get annual bonuses for providing quality treatment to their diabetic patients.

The details of the third phase, which will focus on cardiac care, will be announced later this year.

The NCQA says that Bridges to Excellence is unique in terms of the size of incentive payments and the number of physicians involved. Participating doctors could earn $10,000 or more in financial incentives. NCQA spokesman Brian Schilling says that there will be "many hundreds" of doctors participating.

Incentives for patients will also be included. "An optional patient reward program is available to encourage employees and family members to take an active role in managing their condition," the NCQA states.

Francois de Brantes, a General Electric official who coordinates the Bridges to Excellence program, says the effort tackles some long-standing concerns by focusing on something everyone agrees with.

"We need to address some fundamental issues in health care — not least of which is to work toward a common goal of quality care," he says.

Managed Care’s Top Ten Articles of 2016

There’s a lot more going on in health care than mergers (Aetna-Humana, Anthem-Cigna) creating huge players. Hundreds of insurers operate in 50 different states. Self-insured employers, ACA public exchanges, Medicare Advantage, and Medicaid managed care plans crowd an increasingly complex market.

Major health care players are determined to make health information exchanges (HIEs) work. The push toward value-based payment alone almost guarantees that HIEs will be tweaked, poked, prodded, and overhauled until they deliver on their promise. The goal: straight talk from and among tech systems.

They bring a different mindset. They’re willing to work in teams and focus on the sort of evidence-based medicine that can guide health care’s transformation into a system based on value. One question: How well will this new generation of data-driven MDs deal with patients?

The surge of new MS treatments have been for the relapsing-remitting form of the disease. There’s hope for sufferers of a different form of MS. By homing in on CD20-positive B cells, ocrelizumab is able to knock them out and other aberrant B cells circulating in the bloodstream.

A flood of tests have insurers ramping up prior authorization and utilization review. Information overload is a problem. As doctors struggle to keep up, health plans need to get ahead of the development of the technology in order to successfully manage genetic testing appropriately.

Having the data is one thing. Knowing how to use it is another. Applying its computational power to the data, a company called RowdMap puts providers into high-, medium-, and low-value buckets compared with peers in their markets, using specific benchmarks to show why outliers differ from the norm.
Competition among manufacturers, industry consolidation, and capitalization on me-too drugs are cranking up generic and branded drug prices. This increase has compelled PBMs, health plan sponsors, and retail pharmacies to find novel ways to turn a profit, often at the expense of the consumer.
The development of recombinant DNA and other technologies has added a new dimension to care. These medications have revolutionized the treatment of rheumatoid arthritis and many of the other 80 or so autoimmune diseases. But they can be budget busters and have a tricky side effect profile.

Shelley Slade
Vogel, Slade & Goldstein

Hub programs have emerged as a profitable new line of business in the sales and distribution side of the pharmaceutical industry that has got more than its fair share of wheeling and dealing. But they spell trouble if they spark collusion, threaten patients, or waste federal dollars.

More companies are self-insuring—and it’s not just large employers that are striking out on their own. The percentage of employers who fully self-insure increased by 44% in 1999 to 63% in 2015. Self-insurance may give employers more control over benefit packages, and stop-loss protects them against uncapped liability.