With epidemics of obesity, heart disease and Type 2 diabetes, Americans have to take better care of themselves. Doctors should do everything they can to treat patients holistically. Highmark’s new incentive program has the potential to help on both fronts.
The insurer has collapsed a handful of incentive programs into a single initiative, True Performance, with the goal of better tracking patient care and better rewarding doctors who consistently deliver high-quality, cost-effective outcomes.
Though Highmark hasn’t specified the size of the program’s bonus pool, it has said that many high-performing doctors will get bigger rewards than under the old programs. In the words of Highmark medical director Amy Fahrenkopf, it “aligns the incentives of both Highmark and the physician” to deliver the right care at the proper price.
How does it work? First, Highmark believes that it will be easier to track physician performance and patient care through one program rather than across several. Second, doctors’ bonuses will be based on patient outcomes and costs. How many patients require emergency department visits for chronic conditions? How many keep their blood pressure and cholesterol under control? How many report leading physically and socially active lifestyles? How many patients with diabetes keep their glucose levels within acceptable ranges? Those are just a few of the criteria that might be measured.
Third, the program is intended to encourage doctors to consider quality and cost issues beyond their own practices. For example, doctors will position themselves for bigger bonuses if they make referrals to other physicians with records of providing high-quality, cost-effective care.
Under the plan, Highmark will nudge the doctors, who will nudge the patients to take better care of themselves. If doctors also are evaluated on how often they inquire about mental health problems and addiction, the program will have the added potential of increasing access to mental health and substance abuse services. It all ties together; physical health affects mental health and vice versa.
Primary care physicians also will receive monthly per-patient fees for care coordination. Highmark spokesman Aaron Billger said they might use the money to hire staff members who would call to check on patients, heading off problems or getting them help sooner than otherwise would be the case.
The program is voluntary for doctors, and not all are eligible to participate because of small patient populations or affiliation with UPMC. UPMC, which has its own incentive programs, considers True Performance just a means to drive more referrals to Highmark doctors, but welcomes the competition from a position of confidence.
People have ample incentive to look after their health, but many don’t. Highmark is taking another tack. A program that promotes holistic health across a wide spectrum of the community is worth trying.
Date: January 13, 2016