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Life Health > Health Insurance > Life Insurance Strategies

Speakers Tout Provider Quality Measurement

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Quality-based financial incentives can be great tools for getting doctors and hospitals to do the things necessary to improve care.

A quality incentive program executive and a health insurance company executive made that argument today here at a forum organized by the Blue Cross and Blue Shield Association, Chicago.

Providers “can’t be told” to make changes in their practices or methods, said Richard Norling, president of Premier, Inc., Charlotte, N.C., a company that is running a quality incentive payment program for the Centers for Medicare and Medicaid Services. “These things can’t be ordered.”

The Premier program started to offer a quality incentive pay program for hospitals 3 years ago, and the 260 participating hospitals have shown consistent increases in the quality of patient care, Norling said.

“There was systemic improvement,” Norling said. “Not gigantic improvement, but systemic improvement.”

Another key to improving care is developing care quality databases, to help locate examples of excellent care that ought to be replicated as well as gaps in quality that ought to be repaired, Norling said.

Another forum speaker, Dr. Samuel Nussbaum, WellPoint Inc., Indianapolis, reported that WellPoint paid more than $145 million in incentives to providers in 2006.

WellPoint uses 46 measures to track the quality of member, Nussbaum said.

The care data can help with “translation of claims data to clinical knowledge” to help providers make decisions while caring for patients, Nussbaum said.


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