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Doc pay-for-performance program set to launch

Quality Health First signs up Anthem, 700 doctors

September 1, 2008

Doc pay-for-performance program set to launch Quality Health First signs up Anthem, 700 doctors

After four years of development, a payfor-performance plan for Indianapolisarea doctors will officially launch Oct. 1.

Quality Health First, the latest service of the Indiana Health Information Exchange, now has 700 primary-care doctors signed up to receive its reports on the quality of the care they give.

And perhaps even more important, the program has contracted with Anthem Blue Cross and Blue Shield of Indiana as the first health insurer to offer bonus payments to doctors based on how well they score.

"We're still in the final throes of contract negotiations with a number of [insurance] payers, trying to get all the details hammered out," said Dr. Marc Overhage, CEO of the Indianapolis Health Information Exchange. He expects multiple health plans to sign contracts by Oct. 1.

Anthem, a unit of Indianapolis-based WellPoint Inc., gave the OK late last month, said Dr. David Lee, Anthem's vice president of health care management.

"We're hopeful that our signing of the contract is the impetus" for more doctors and health insurers to sign up, Lee said. The program hopes to add another 500 primary-care physicians this year.

Quality Health First was conceived four years ago by the Employers Forum of Indiana, a group of benefits administrators of central Indiana's largest employers, as well as health plans and hospital groups.

Quality Health First has been pilot-testing since November. But as of Oct. 1, the quality reports will start to count toward bonus payments-at least for services doctors provide to patients with Anthem insurance.

"It's like the Colts moving from the preseason into the regular season," said Russ Towner, chairman of the Employers Forum. "Now, all the statistics and the measures, they will count."

Anthem has agreed to give bonus payments ranging as high as 10 percent of the total reimbursement a doctor receives from Anthem for in-office services.

Such services, also known as evaluation and management, make up about 60 percent to 80 percent of the reimbursement payments most primary-care doctors receive, Lee said.

He estimated that a 10-percent bonus payment would, for the typical central Indiana primary-care doctor, range from $10,000 to $20,000 per year.

Anthem would make those 10-percent bonus payments to the doctors that fall into the top 20 percent on Quality Health First's quality reports. Doctors falling below that group would get progressively smaller bonus payments. Doctors falling below the 30th percentile would most likely get no bonuses, Lee said.

The quality reports score doctors in 26 areas. But to start, Anthem and other insurers would base their incentive payments on just six things, all designed to address chronic diseases, which account for more than 70 percent of all health care spending.

Those criteria include giving appropriate medications to asthma patients, doing breast-cancer screenings for women, keeping heart patients' levels of LDL-or "bad"-cholesterol at healthy levels, and screening diabetics for blood-sugar levels.

Reports show the percentage of each doctor's patients who have received recommended care or achieved recommended levels of cholesterol or blood sugar.

Quality Health First compiles its reports based on claims data provided by health insurers and the federal Medicare program. It also uses data from lab test results and doctors' reports.

Even government programs, such as Indiana Medicaid, are interested in using Quality Health First to offer performance-based bonuses to doctors.

Dr. Jeff Wells, director of Medicaid Indiana, said, "We have an absolute interest in seeing improvements in the quality of life in the Medicaid membership and to deliver that care as efficiently and as costeffectively as possible."
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