Health plans signal willingness to alter doctor pay

A recent survey highlights how eager health insurers are to have physicians participate in new models of paying for care.

In a poll of 170 health insurance executives, 69% said their organization is planning to participate in or support accountable care organizations during the next three years. Sixty-six percent said their company would participate in pay-for-performance programs. And 52% said they would participate in “other models involving new payment approaches.”

The survey, released in January, was conducted by HealthEdge, a Massachusetts-based software company that serves health care payers.

Beyond paying incentives to physicians that health insurance executives hope will save money and improve care, they are focused on giving incentives to members to adopt healthier habits. In the survey, 58.8% of executives said their company would participate in value-based benefit designs, such as co-pay or premium reductions or waivers for members who report they are, for example, exercising regularly.

The survey did not discern whether the executives' companies already were participating in the new payment models.

A Nov. 26, 2012, report by the consultant Oliver Wyman estimated that 25 million to 31 million patients receive care through ACOs. Leavitt Partners, another health care consultant, counted about 330 accountable care organizations in operation as of Nov. 1, 2012, up from 164 in 2011.

Hard to get on board

Other studies have found that forming ACOs and instituting new models of care often is easier said than done.

A December 2012 report from the Commonwealth Fund looking at 59 ACOs found that none had met six core components that were considered essential for an ACO to be considered fully implemented, and some hadn't met any. Among the problems cited were the difficulty of organizing physician networks and ensuring that payers, doctors and hospitals had the right technology to manage patient populations.

The health plan executives in the HealthEdge survey had varying levels of confidence that their organizations had the technology they needed. Forty-one percent said they don't have the technology for ACOs. Thirty-four percent said technology was lacking for pay-for-performance programs, and 47% said they lacked technology to implement value-based benefits. Many said they weren't to the point of processing claims electronically.

Twenty-five percent said they manually process about 40% of their claims. Processing costs about $6 per claim for 65% of respondents and more than $9 per claim for 10% of participants. HealthEdge executives echoed previous surveys, which noted that many payers and physicians had yet to make the technology investments for new payment models to work as planned.