Six California health plans are expected to announce Tuesday what they call an "unprecedented" effort to improve patient care and control spiraling health-care costs by rewarding doctors and hospitals for quality, not just efficiency.
Such an agreement between separate health plans, billed as the first of its kind in the nation, would represent a major step in an extremely competitive industry. It also adds another wrinkle to the rapid evolution of the nation's health-care system, which is struggling to build a new model out of the financial wreckage of managed care.
Analysts say that within a year or two there will be a fundamental shift in the way health care will be assessed, chosen and delivered to consumers. The bottom line for 2002 and beyond: Employers will pass increasing health-care costs directly to employees in the form of higher premiums, higher co-payments, tiered medication costs and higher deductibles, and with them more of the responsibility for making the most effective and efficient choices.
Sources said that the participants, Aetna Inc., Blue Cross of California, Blue Shield of California, Cigna Corp., Health Net Inc. and PacifiCare Health Systems Inc., have agreed on a common set of standards for measuring performance under which doctors and hospitals will be rewarded with bonuses of at least 5% of the billed amounts for providing quality health care and for avoiding medical errors.
The move follows an announcement last July by Blue Cross that it would begin rewarding doctors in its health maintenance organizations for patient satisfaction rather than cost savings.
Meanwhile, beginning later this month, the New York-based employees of some of the nation's largest companies, including IBM Corp., Xerox Corp., Verizon Communications and PepsiCo Inc., will be able to access a Web site that contains the beginnings of another new approach to health care: information on which of nearly 150 hospitals in the area have the most experience and the best outcomes on a variety of surgical procedures.
"These are issues that have been talked about a lot, but health care is an extraordinarily decentralized industry," said Gregger Vigen, a senior consultant at William M. Mercer, one of the nation's largest health-care consulting firms. "Just getting a Web site up with this kind of information represents a big step forward."
