Employers to emulate Medicare by buying quality care

Eighteen businesses and labor organizations agree to align with a national program by participating in quality-based purchasing initiatives.

By Charles Fiegl amednews staff — Posted July 26, 2012

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Employers and labor organizations will follow Medicare’s lead in paying physicians and hospitals based on the value of their care, agreeing to purchase health plans for workers that reward health professionals for care quality and efficiency.

A coalition of 18 large employers and unions has agreed to align with Medicare’s value-based purchasing programs, such as an initiative to share savings from lowered health spending, through a collaborative called Buying Value. The project offers employers guidance for how to purchase the best health plans that reward quality.

The private purchasers will have an active voice in health coverage instead of just paying the bills, said Gerald Shea, assistant to the president of AFL-CIO, one of the participating groups. Although many insurers already have their own quality initiatives, the participants and the Medicare program will establish common measures for purchasing value.

“When we started talking about it, everyone thought we should not go on our own way but follow what Medicare is doing,” Shea said. “We’ve seen the chaos with purchasers that put in their own program.”

For instance, the private sector coalition could align with Medicare’s accountable care organization program. The collaborative also could try new initiatives, such as lowering co-pays for patients seeking health services and professionals known for high quality, Shea said.

By 2017, 9% of Medicare payments will be linked to a quality initiative, according to the Robert Wood Johnson Foundation, which is assisting the project.

Buying Value aims to help the organizations — which also include IBM, Maine Health Management Coalition and the National Education Assn. — switch from traditional insurance models to those rewarding physicians and hospitals for value and providing patients with more education to improve their outcomes. The first phase, establishing a core set of quality measures for both Buying Value and Medicare, is expected to be completed by Oct. 1.

The Robert Wood Johnson Foundation is supporting the program by using databases to aid in purchasing health plans that drive quality, complying with antitrust laws regarding active purchasing, and developing resources that explain new benefits.

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