Early results of a pay-for-quality pilot program reveal improvements in quality of care and reductions in emergency room and hospital admissions.
The preliminary results were released by HealthSpring Inc., one of the country's largest coordinated care plans, whose primary focus is the Medicare Advantage market.
HealthSpring's Pay for Quality pilot structures reimbursements for physicians to encourage more extensive preventive care, rewarding physicians for performing key preventive screenings and check-ups.
Preliminary results showed improvement when physicians increased preventive screening in the following areas:
&x#2022; Physicians increased mammography screening by 68 percent;
&x#2022; Physicians increased pneumonia screening by 65 percent;
&x#2022; Physicians increased influenza screening by 192 percent;
&x#2022; Physicians increased colon cancer screening by 27 percent;
&x#2022; Physicians increased diabetic eye exam screening by 93 percent;
&x#2022; Physicians increased diabetic foot exam by 378 percent.
Preliminary results also showed:
&x#2022; Emergency room visits per 1,000 were reduced by 7 percent;
&x#2022; Hospital admissions per 1,000 were reduced by 11 percent;
&x#2022; Health plan's medical cost ratio was reduced by 8 percent.
"While these are preliminary results, we feel very encouraged that the numbers show our Pay for Quality pilot has made a significant impact on care and quality of life for our members," HealthSpring chairman, president and CEO Herb Fritch says. "We are really starting to see evidence that we're making headway in helping to keep our members healthy rather than just reacting once they're sick."
The pilot program covered three states and nine practices with 87 physicians and 7,468 members in 2007. Duration for the pilot is three years for one practice and one year for all others.
"The focus is on preventing complications and catching problems before they become serious," HealthSpring Medical Director of Quality, William Anderson, MD, said "This is a win for everyone involved. Providers are rewarded for delivering the highest quality care, members are healthier and enjoy a better quality of life, and healthcare costs are reduced because the member doesn't need treatment for serious complications. There has been a lot of talk about pay-for-performance models recently."
"HealthSpring has been on the leading edge of exploring this concept, and we're really seeing positive results," he said. "We think these numbers are beginning to show clearly that healthcare in our country must move towards this type of model that places the emphasis on wellness and prevention.
Sid King, MD, a medical director for HealthSpring and managing partner for a medical group participating in the pilot, also views the partnership aspect of the program as vital. "It's this idea of health insurer and provider working together to keep members healthy that is proving to be so effective," King said.
HealthSpring continues to expand its Pay for Quality pilot. The program currently includes 27 sites, 348 physicians and 25,000 members with plans to further expand to a total of 35-40 practices, more than 400 physicians and more than 40,000 members by the end of the year.