California doctors closer to reaping bonuses

Insurers participating in the performance initiative announce payouts; tougher quality standards are expected in 2004.

By Mike Norbut, amednews staff. Oct. 6, 2003.

Physician groups involved with Integrated Healthcare Assn.'s "Pay for Performance" are getting more information about what their quality bonuses will be.

When organizers announced the initiative, which is estimated to affect some 40,000 physicians, they estimated bonus totals between the six participating health plans could reach $150 million. The most frustrating aspect of the initiative for physicians, however, has been waiting for plans to announce how much money they will contribute to the project, and how the bonus payments would be made.

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Beau Carter, IHA executive director, said that last month he put together a comprehensive spreadsheet of bonus plans after the last insurer, CIGNA, made its intentions public. Because of antitrust issues, insurers were prohibited from discussing payment plans with each other.

In addition to its current "Provider Group Rewards Program," CIGNA also plans to reward the top 50% of groups in each of the IHA categories. Top performing groups would receive a minimum of $1.60 per member per month. Other plans have continued to operate their own bonus initiatives before making payments under the IHA initiative next year. Blue Cross of California, for example, recently announced $28 million in payouts to about 80 groups across the state.

Bonuses were paid according to group quality scores and how many members they have, a common approach to payments that Carter said has not been an issue with physicians.

While physician groups will see the fruits of their IHA labors next year, they also may see some tougher standards to reach as well. Although it's unlikely new measurements will be added, Carter said, it is likely that thresholds in some categories may be raised. New plans also are expected to join the initiative in 2004. Western Health Advantage, a regional plan based in Sacramento with about 65,000 members, will join the initiative in 2004 for payments beginning in 2005, Carter said.

"Pay for Performance" currently consists of six of the largest health plans in California: Aetna U.S. Healthcare, Blue Cross of California, Blue Shield of California, CIGNA Healthcare of California, Health Net, and PacifiCare Health Systems. Carter said he was talking to at least two more plans.