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Life Health > Health Insurance > Life Insurance Strategies

Researchers Find Wide Variations In Pay-For-Pay Programs

By Staff Writer

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Health insurer efforts to measure and report the quality of doctors and hospitals are in their infancy.

A PricewaterhouseCoopers L.L.C. team led a health industries specialist in the firm’s McLean, Va., office have come to that conclusion in a study based on a review of 10 established “pay for performance” programs.

The federal government wants to make “P4P” compensation a standard part of government health finance programs, but a review of the existing private-sector P4P efforts shows that if “you’ve seen one pay-for-performance program…you’ve seen one pay-for-performance program,” the PricewaterhouseCoopers researchers write.

The companies use about 60 indicators to measure performance, but no single indicator is used by all 10 plans, the researchers report.

Only 1 plan looked at whether doctors helped smokers to quit smoking, and only 1 looked at patients’ satisfaction with their level of access to a physician.

Despite reports of New York regulators expressing concern about performance-based compensation systems, most carriers seem to be leery about creating “tiered” provider networks or taking other aggressive steps to steer patients toward higher-rated providers, the researchers report.

In many cases, the payment system is so broken down that P4P programs seem to be “putting lipstick on a pig,” industry players told the researchers.

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