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Published: Monday, 9/1/2003

Blue Cross to reward doctors for quality care

BY LUKE SHOCKMAN
BLADE STAFF WRITER

Paying a hospital or physician more money if they do a better job may seem so logical that all health insurers should do it, but few do.

However, one of the larger insurers in northwest Ohio is trying.

Anthem Blue Cross and Blue Shield, which has about 250,000 members in northwest Ohio and is the largest insurer in the state, has signed a multiyear pay-for-performance agreement with ProMedica Health System and 145 ProMedica physicians.

“Typically, insurance companies negotiate about money with hospitals year in and year out, but never has anyone put patient care and quality on the table,” said John Jesser, vice president of Anthem's northern Ohio region.

ProMedica hospitals in the Anthem agreement include Toledo Hospital, Flower Hospital in Sylvania, Bay Park Community Hospital in Oregon, Defiance Regional Medical Center, and Fostoria Hospital.

Anthem will measure how well the hospitals and physicians do on a variety of quality and satisfaction indicators, such as infection rates, how long patients wait in emergency rooms, how many women get mammograms, how many children get vaccinations, and whether doctors offer weekend and extended hours.

If hospitals and doctors meet or exceed set targets, they are paid more.

For example, one target is to screen at least 72 percent of women who qualify for mammogram screening. Another is to get 75 percent of qualified women screened for cervical cancer.

The effort may cost more money in the short term if physicians and hospitals order more tests, but Mr. Jesser said “at the end of the day, good quality will lower costs. If people are getting, for example, the screenings they need, you'll detect cancer earlier and lower costs.”

Susan Pisano, spokesman for the American Association of Health Plans, said efforts like Anthem's are becoming more popular, although still relatively rare.

“There's been more focus on the fact that we want to promote quality, but we pay the same for good quality as bad quality,” she said.

Anthem and ProMedica officials won't share the results of how well the hospitals and physicians are doing with their patients or members.

Suzanne Delbanco, executive director of the Leapfrog Group, a nationwide effort that employers started to improve patient quality, said Anthem's effort is noble, but consumers deserve to know the results and “become a part of the equation.”

Michael Taddeo, vice president of network management for Medical Mutual of Ohio in Cleveland, said Anthem's goals are good, but he thinks a better method would be to educate physicians. If they can't meet performance goals, then exclude them from a coverage panel, which is what Medical Mutual does.

“I'd rather not do business with those not providing quality care,” he said.



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