In Pennsylvania, Insurers Pay Primary Care Docs to Do More
From Minnesota,
the Health Blog State Health Reform Tour now heads to Pennsylvania,
where big insurers have signed on to the governor’s plan to try
changing the way primary care docs are paid.
The insurers will spend $13 million over three years to finance the program, which will include more than 150 docs and over 200,000 patients, the Philly Inquirer reports. Independence Blue Cross and Aetna are among those participating.
Look hard enough at the plan, and you can find elements of most buzzwords tripping off the lips of health reformers these days.
The doctors will be creating a medical home, an accessible place that patients can visit on short notice and reach via phone and email to coordinate their medical care. Pay for performance is there as well, with docs getting paid not by the procedure, but based on “how well they dispense proven treatments and keep patients healthy,” the Inky says. And what would pay for performance be without health IT? The docs will get special software allowing them (and the insurers) to track the patients.
Gov. Ed Rendell has said the plan could ultimately save money, but an expert the Inquirer talked to was skeptical.
“In many ways, it is a return to the idea of integrated delivery, which is the original concept behind HMOs,” Mark V. Pauly, professor of health-care management at the University of Pennsylvania’s Wharton School, told the paper. “I doubt it would save money. . . . The best we can hope is that it will improve the quality of care.”
Photo via Wikimedia Commons
If my reimbursements, as a health care provider, were based on how well I kept patients healthy; then, I would do everything I could to preselect an already healthy patient population. Which is exactly what HMO’s and insurance companies do in the first place. Besides, an ounce of prevention is worth a pound of cure. Promoting healthy life styles will save more money than speeding up access to health care.
I agree with Mr. Reilly. Cherry picking of healthy patients will occur. When Medicare HMOs started about 5 years ago, I saw a sudden influx of new, sick-as-hell patients who had let their chronic illnesses mature into ripe disasters and were attracted to the new plans because there were no (or very limited) co-pays and free meds (up to a point). The insurance companies were being reimbursed at the 90% Medicare rate and I foresaw that they would soon run out of money. My reimbursement for providing for their complex care was the same as caring for my existing traditional Medicare patients who were wise enough to have adequate co-insurance and had the money and wisdom to take care of their health problems and thus control their medical costs. General physicians and specialists were dropping of these plans fast and before I could do the same, the insurance company went bankrupt. Insurance companies have no desire to improve care, only to not pay out more than they take in. And the more they can keep, the better for them. “Pay for performance” is another attempt to increase their profits and is a scam perpetrated on physicians (who will again work more for less) and complex patients who will have difficulty finding caring, competent physicians. Watch for the development of the preappointment interview…
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