As the government’s work on healthcare reform gathers steam on Capitol Hill, America’s Health Insurance Plans is shining the spotlight on private-sector strategies it says are critical for change – among them the adoption of electronic health records.
“There is widespread agreement that delivery system reforms are needed to improve patient care and make healthcare more affordable,” AHIP President and CEO Karen Ignagni said at a news conference last month. “Health plans are pioneering the types of innovative approaches necessary to move to a 21st century, evidenced-based healthcare system.”
AHIP also released a new publication, Innovations in Recognizing and Rewarding Quality. It details payment models that recognize and reward physicians and hospitals for achieving national benchmarks, demonstrating outstanding performance, and making measurable improvements.
AHIP notes that among the results of employing P4P are:
• Greater adoption of new technologies, such as electronic medical records, e-prescribing, and patient registries;
• Better adherence to evidence-based treatment guidelines for patients with chronic conditions, such as diabetes, asthma, and coronary artery disease;
• More patients getting recommended treatment following hospitalization;
• Reduction in emergency room visits;
• Increased adherence to recommended preventive screenings and vaccinations
“As our nation struggles with rising healthcare costs, health plans are piloting new payment models that are making the system more affordable and improving value and quality,” said Lewis Sandy, MD, senior vice president of clinical advancement at UnitedHealth Group.
It makes sense, agreed Roberta Herman, MD, chief medical officer and senior vice president at Harvard Pilgrim Health Care.
“Rather than simply being reimbursed for the volume of care provided, physicians and hospitals should be rewarded for intervening early, managing care efficiently and improving health outcomes,” Herman said.
“There is still wide variation across the country in how physicians practice and what care they give, and as a result, research shows that Americans continue to spend significant healthcare resources on inappropriate and unnecessary care,” said Steven Udvarhelyi, MD, senior VP and CMO at Independence Blue Cross. Udvarhelyi noted reports that show that poor performance in the healthcare system results in 79,000 avoidable deaths, 66.5 million sick days, and $1.8 billion in excess medical costs each year.
