standardized method to judge provider performance that passes muster with critics
of health plans’ previous doctor ranking efforts is likely to boost the consumerism
movement by providing plan members with tools to choose their doctors, observers
say.
The methodology, which is based on a set of principles
developed by the Washington-based Consumer-Purchaser Disclosure Project, also should
give employers greater confidence that the rankings insurers use to establish high-performance
networks are based on both cost and quality, they say.
The
Patient Charter for Physician Performance Measurement,
Reporting and Tiering Programs was unveiled in early April by the
Consumer-Purchaser
Disclosure Project,
a collaboration of employers, consumers, labor organizations, insurers and providers.
The group has been working for more than five years to establish a set of principles
to rate provider performance that would satisfy all of their competing concerns.
Elements of the Patient Charter were incorporated into
an agreement last October that settled a lawsuit brought by New York Attorney General
Andrew Cuomo against Bloomfield, Connecticut-based Cigna Corp. over its doctor ranking
program.
According to the charter, standards will be developed
and their implementation will be reviewed by independent health care quality rating
organizations, such as the National Committee on Quality Assurance and/or the Utilization
Review Accreditation Commission, both based in Washington.
Because the National Committee on Quality Assurance
has already developed a set of standards that meet the criteria set out in the charter,
the organization’s Physician and Hospital Quality Program is likely to be the first
to be used, says Peter Lee, executive director for national health care policy at
the San Francisco-based Pacific Business Group on Health, which is a member of the
Disclosure Project. Lee is co-chair of the Disclosure Project.
The quality program, once part of the National Committee
on Quality Assurance’s health plan accreditation program, now is a stand-alone program
that evaluates how well health plans measure and report the quality and cost of
physicians and hospitals, a committee spokesman says. The program was updated and
released for public comment last month and is expected to be finalized by July,
he says.
However, it is possible that more than one set of standards
could meet Patient Charter criteria, eventually providing insurers with an option
of choosing one or more of the accreditation programs, Lee says.
For example, the Utilization Review Accreditation Commission
last week released for public comment revisions to its Health Plan and Health Network
Accreditation standards that could meet criteria set forth in the charter, he says.
After the first set of standards receives the Disclosure
Project’s endorsement in less than six months, the first four insurers to support
the charter—Cigna, Aetna, WellPoint and UnitedHealthcare—will have three months
to begin the review process and six months to complete it, says Debra Ness, president
of the Washington-based National Partnership for Women & Families and co-chair of
the Disclosure Project.
Cigna could become the first insurer to complete the
review process since it has had a head start as a result of its work with the New
York attorney general, she says.
In the meantime, the Disclosure Project will encourage
other insurers to undergo the review process, Lee says.
Several members of the health benefit community view
the charter as an important step that will give consumers reliable information to
help them make informed choices about their health care.
"Our employees and their dependents need these
programs so they can better navigate the health care system and select
physicians they can put their trust in," said Andrew Webber, president of the
National Business Coalition on Health, at a press conference last week in
Washington announcing the charter, according to a transcript of his speech. The
coalition is made up of employer health care coalitions based in Washington and
is among
supporters of the accord.
"NBCH believes the Patient Charter will promote national
consistency and transparency in how health care plans establish these important
physician-level measurement programs, something that is critically important, particularly
to national employers who have a workforce spread throughout the country," Webber
said.
Standardizing doctor performance measures also is likely
to expand the health care consumerism movement by finally providing employees with
the tools they need to select their doctors, says Francois de Brantes, CEO of Bridges
to Excellence, an employer pay-for-performance initiative that also backs the charter.
"Consumers really don’t trust the payers to deliver
objective data on the quality of physician care, even if it’s well-done. So taking
it out of that setting and making it more objective should greatly improve the credibility
of the data and, hopefully, its actionability by consumers," de Brantes says.
"The move toward consumerism … will definitely get a
boost from having this information available," according to a spokeswoman for America’s
Health Insurance Plans. The Washington-based health insurer trade group is among
supporters of the Patient Charter, which is similar to principles endorsed by the
organization’s board in November, the spokeswoman said.
But Regina Herzlinger, the Harvard Business School professor
credited with launching the health care consumerism movement, says the charter may
not have everything consumers need to safely navigate the health care system.
"Virtually all the measures focus on process," Herzlinger
says. "Until we have outcome measures, we are wasting our time."
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