HMO Vows to Unscrew-up Outdated Incentive Program
By John Millrany - July 19, 2001Of all the aphorisms one hears on the medical front, we can
look to US statesman and financier Bernard Baruch to set us straight on
the contemporary whys and wherefores of what HMOs are up to in California. He
said, in 1924, “There are no such things as incurables, there are only things
for which man has not found a cure.”
Right now, it’s Blue Cross of California that is
taking the lead on how to straighten out part of its own mess as a major player
in the Health Maintenance Organization industry. Always looking for a
cure, Blue Cross immodestly claims it is taking the lead role in making
medicine better for you and me—not to mention its employees and constituent
medical groups.
Medical research and development aside, the preponderance of
health care professionals have known for some time that patient satisfaction
is the most important factor in medical relationships. Blue Cross, which is
a division of Thousand Oaks-based WellPoint Health Networks Inc., has in
fact utilized a point system for “indicators” of quality heath care delivery
since 1994.
Ostensibly, the points-indicator system—reportedly
assiduously utilized by a fourth to one-third of all Blue Cross medical groups—just
didn’t practice all it preached.
And so it came to pass that Blue Cross (California’s fourth
largest HMO with 5.6 million members) has introduced a bonus program that will
reward physicians groups that meet certain scorecard criteria. On July 11, it gathered
the press to announce “a major restructure to pay for and reward” its medical
groups for amping up quality care—hence, patient satisfaction, according to Jeff
Kamil, MD, the HMO’s medical director and vice president of medical policy
and quality.
Saying the updated program focuses “exclusively on quality
of care,” Kamil emphasized, “We believe this change is necessary for out
market. (We are going) to restage and reformat health care delivery in
California,” moving from what was formerly cost-containment-driven issues to
the new mantra: Quality care.
Kamil said Blue Cross employees, patient members and the
medical providers themselves are all in accord on the “reformatting, ” which
will stress “quality in the right way, at the right time and in the right
place.”
He also denied that the timing of the announcement had
anything to do with the universal Patients’ Bill of Rights bill, which includes
particulars on how to sue HMOs and is now under consideration in Congress.
Michael Belman, MD, Blue Cross staff vice president,
averred that his HMO has set the standard for quality by its “quality
scorecard” system, but promised to increase the scale (based on a factor of 200
points) because “change is required.”
Also appearing at the press conference was Tom Rosenthal,
MD, a true heavyweight carrying the imprimatur of UCLA (per usual,
regarded as among the top five hospitals in the US) who is director of the
physicians HMO group at the university. Rosenthal said his team, consisting of
1,000 physicians and a patient base of 80,000, supports the “ideals in this and
supports in particular the items that have been selected to be incentivized.”
From the physicians group perspective, he said, the “patient’s own reporting of
their health care experience is an extremely important measurement of quality
of care…”
In
its official press release, Blue Cross said the restructuring plan is “in response to feedback from both consumers
and physicians. Recent surveys among medical groups in California have shown
that physicians who receive rewards for superior performance related to
clinical care and patient satisfaction are more satisfied with their work and
are better appreciated by their patients.”
Acting upon the feedback of physician
partners and with the endorsement of their external Physician Relations
Committee, Blue Cross dubbed the new program “Primary Care Physician (PCP)
Quality Measurement and Bonus Systems” with a customized “quality
scorecard.” The scheme awards points to physician groups, which have an
internal process for measuring the quality and clinical performance of each
doctor and a system for disbursing award bonuses to those practitioners who
score well.
“The quality measures, which are determined
by each medical group, may include such items as patient satisfaction surveys,
waiting times for appointments, number of complaints and grievances, peer and
staff reviews and patient turnover. In addition, the measurements will also
include physician performance in managing chronic diseases such as asthma or
hypertension and adherence to screening guidelines for breast and cervical
cancer. Blue Cross of California believes it is the first health plan to
formally recognize physician groups who use these evaluation tools,” the HMO
said.
“We commend Blue Cross of California for this
important advance in rewarding delivery of high quality health care and patient
service by its physician groups,” said Peter Lee, president of Pacific
Business Group on Health. “Collecting and reporting data significantly
affects performance; we believe the new PCP Measurement category is an
important element in promoting physician accountability and member
satisfaction."
Also, under the revised quality scorecard,
more than half of a medical group’s score will now be based on patient health
outcomes and patient satisfaction.
Dr. Robert Crocker, WellPoint’s senior vice president of health
care quality assurance and clinical affairs, stated, “This system of
measurement is a direct response to our members, employer groups and market
demand for more accountability to be focused on their medical care. If
our medical groups can be successful in achieving the appropriate health outcome,
then cost savings will be an automatic byproduct of the process. We know
that the best care is that which is given in the right place at the appropriate
time. This also happens to be the most cost-effective care.”
From another perspective, “Neither physicians
or patients are satisfied with the current focus of cost and utilization
controls,” observed Steve McDermott, CEO of Hill Physicians Medical
Group. “With its new quality scorecard, Blue Cross is working to
shift the focus where it belongs—on
quality of care and patient satisfaction.”
Blue Cross noted that the new incentive
program will be implemented continuously as new contracts are renegotiated with
each medical group in its HMO network.
Many other HMOs are expected to follow Blue
Cross’ counterattack to what has often been criticized as a ponderous and
sometime onerous way to run a business, medical or otherwise.
Is
it too soon to say, “My body (and peace of mind) thanks you, Blue Cross”?
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