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GOOD-DOCTOR BONUSES HMOS LAUNCH 'PAY FOR PERFORMANCE' INITIATIVE.

Byline: Evan Pondel Staff Writer

Six California health maintenance organizations joined together Tuesday in launching a $100 million pool to pay bonuses to doctors who provide high quality care and get high marks from patients.

The announcement comes at a time when the health care industry, particularly HMOs, faces intense criticism over putting cost-cutting ahead of quality of care.

The Integrated Healthcare Association's ``Pay for Performance'' initiative links several players in California's health insurance arena covering more than a third of the state's insured population. The participants include WellPoint Health Networks Inc.'s Blue Cross of California subsidiary; Health Net Inc.; PacifiCare Health Systems; Aetna Inc.; Blue Shield of California and Cigna Corp.

``The goal of any payment should be to reward value of care,'' said Beau Carter, executive director of IHA, a consortium of health plans, medical groups and academics based in Walnut Creek, Calif. ``With this initiative, employers get better value for their premium dollars.''

IHA has been working with the six insurers for the past year to formulate a scorecard that measures preventive and diagnostic standards, chronic-care efficiencies and overall patient satisfaction. IHA anticipates that all six insurers will implement the new system by 2003.

But just how the money will be divvied up hasn't been decided.

Though the intention of the scorecard is to improve the quality of care and reward the physician, some doctors remain skeptical of the initiative's efficacy.

``It's a lovely public relations move,'' said Dr. Ilena Blicker, president of the Los Angeles County Medical Association, an organization that lobbies to protect physicians. ``Where is this extra (bonus) money going to come from?''

With premiums expected to increase in the high single digits or more for at least three more years, Blicker said, this supposed scorecard could be responsible for part of the rise in health care costs.

Dr. Michael Belman, medical director for quality management for Blue Cross of California, said the cost of such a plan is already built into the initiative and will not translate to higher costs for the consumer.

``I don't think there is an additional financial load,'' Belman said. ``And from the physician's perspective it starts putting money in areas which will reward them for a good job.''

Still, 50 percent of the scorecard will rely on clinical testing and about 40 percent will account for patient satisfaction, a formula that might be hard to standardize among different hospital settings, physicians and patients.

``Everyone that has taken statistics knows that data can be interpreted in different ways,'' Blicker said. ``We all want to have quality medicine ... but the data from these scorecards could mean different things to different people.''

Even so, for the consumer, the implications of a scorecard appear far more positive. Marc Moser, chief executive officer of Torrance Hospital Independent Practice Association, said the idea behind a scorecard is beneficial for consumers.

``I think anything that encourages the provision of appropriate service is a good thing, and the outline is there,'' he said.

What concerns Moser is that reimbursements for doctors in California have been paltry and that if the scorecards simply provide bonuses, the insurance companies could be affixing a small bandage to a wound that's a lot larger.

``It wouldn't be fair and my concern is that this doesn't mask or become a way to say the insurance companies are trying to increase reimbursements to produce better outcomes,'' Moser said.

At Woodland Hills-based Health Net, spokeswoman Lisa Kalustian said that isn't the impetus of the scorecard.

She said Health Net and the other five insurers are working together to improve the way health care functions in California for both the consumer and physician.

``The beauty is that through a collaborative effort, you're truly trying to identify, acknowledge and reward for the quality our customers are looking for,'' Kalustian said.

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PAYING FOR PERFORMANCE

SOURCE: Integrated Healthcare Association
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Publication:Daily News (Los Angeles, CA)
Date:Jan 16, 2002
Words:647
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