The Race Is On (And It's Not the Indy 500)

The pay-for-performance concept is getting realer and realer. At least that's how things seem to be evolving these days. According to an October 16 report in theIndianapolis Star-Tribune, Anthem Blue Cross and Blue Shield of Indiana, now a part of the gigantic nationwide WellPoint health insurance conglomerate, is planning to increase physician payments by up to 10 percent next year if their patients receive recommended care, such as a middle-aged woman getting a mammogram or someone at risk for heart disease getting a cholesterol test. According to the Star-Tribune report, Anthem expects to pay out about $8 million in added reimbursement for office visits for hundreds of Indianapolis-area primary care physicians. Given that Anthem is by far the state's largest private insurer, covering 2.5 million people in that state, such a move could be very impactful in the broader scheme of things. And how is Anthem going to obtain the data and information necessary to be able to figure out which physicians to pay differentially? According to the Star-Tribune article, the program will draw information from the Indiana Health Information Exchange's Quality Health First program. IHIE, the newspaper says, is "an Indianapolis-based nonprofit company that operates a widely used messaging service that allows thousands of area health-care providers to access lab results and other medical information securely over the Internet." See how all these puzzle pieces are starting to fit together? What's clear from this Indiana example is that the broader availability of more granular data on provider actions and behaviors will soon enable more managed care payers to push down more precisely on the levers of reward and recognition in the health care system. Meanwhile, given that the vast majority of the nation's physicians are still working in a relatively impoverished data and IT environment, it's also clear that hospital organizations are going to continue to be very important partners to doctors as they jointly and severally negotiate the emerging world of differential pay. As is the usual case in healthcare in the U.S., things will inevitably move at different speeds among different payers in different states. But CIOs and other healthcare IT leaders are going to need to move sooner rather than later to help their organizations, and their affiliated and allied physicians, to respond to the growing demand for accountability and improved performance in the healthcare system. And things are only going to move faster, I believe, as this country's economic troubles put more and more financial pressures on healthcare purchasers--pressures that can only trickle downward through the system.