Large Massachusetts Employers, Health Plans To Pay Providers for Quality Care

Beginning next year, several large employers and health insurers in Massachusetts will offer eligible physicians bonuses for providing high-quality health care in the hope that improving care now will lower costs in the long term, the Boston Globe reports. Program participants include General Electric, Verizon Communications, hospital network Partners HealthCare and the provider group Lahey Clinic; Tufts Health Plan also is considering joining. Under the program, Massachusetts doctors treating employees at participating companies and members of participating health plans are eligible for annual per-patient bonuses of $50 or $100. If a doctor becomes a member of the American Diabetes Association's provider recognition program, the physician will receive $100 per patient if he or she properly controls a diabetic patient's blood pressure, cholesterol, blood sugar and other "dangerous indicators." In addition, a physician will receive a $50 per-patient bonus for non-diabetic patients if he or she establishes an electronic patient database, creates a system to regularly follow up with chronically ill patients and implements patient education programs. As more employers and health plans join the program, the bonuses will increase, the Globe reports.

Implementation
The program is "one of the largest initiatives in the country" to change the way managed care rewards physicians, the Globe reports. Similar bonus programs will be launched in January by six health insurers in California, and General Electric, Verizon and other employers plan to launch programs similar to the Massachusetts one in Ohio and Kentucky. The Institute of Medicine also recently recommended that Medicare and Medicaid programs award doctors and hospitals bonuses for quality care. Francois De Brantes, General Electric's program leader for health care initiatives, said, "If someone said to you no matter what you do at work this year, you're going to be paid the same, you'd be out for two-hour lunches. We need to find a way to get the system moving in the right direction." But Beau Carter, executive director of Integrated Healthcare Association, said, "Saving dollars by managing diseases and patient care is a better solution now, but it's going to be tough to do. The first obstacle is overcoming the distrust built up between health plans and doctors." Dr. Charles Welch, president of the Massachusetts Medical Society, said that many of the bonuses offered through the programs are "really small," amounting to about 5% or less of a doctor's salary. He added that many doctors are worried that the bonus money is simply being taken out of their regular contracts. "We all agree a physician who does a really good job should be paid more than one who doesn't. The disagreement is about what measures you use to determine quality, how much of an incentive is meaningful and whether you get it by taking it away from another doctor," Welch said (Kowalczyk, Boston Globe, 11/7).