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Less Than 1% of Health Plan Premiums Spent on Quality

John Commins, for HealthLeaders Media, March 22, 2013

It also identified substantial variations in quality improvement expenditures ranging from $40 per member among the top quartile to $12 per member in the bottom quartile.  The median expenditure among provider-sponsored plans was $37 per member and $23 by non-provider-sponsored plans. Nonprofit plans spent $35 per member and for-profit plans spent $19.

Robert Zirkelbach, spokesman for America's Health Insurance Plans, says insurers have complained that federal regulations weren't "capturing all of the activities that plans do to improve quality for patients."

"There is a big move towards partnering with doctors and hospitals to change how we pay for care so we are rewarding quality and value over volume of services provided. Plans are doing that all across the country, but that is not reflected in these numbers," Zirkelbach said.

"Plans increasingly provide patients with more access to information and data about quality and cost of medical services, providing online and on mobile devices, information and claims history personal health records so they can make more informed health decisions. That is not included."

"We are making sure that more physicians in health plan networks are providing high-quality care, credentialing them, making sure they provide the kind of care that patients need, but that isn't included. Efforts to prevent and deter fraud from occurring in the healthcare system that has not only cost implications, but patient safety and quality implications as well, [such as] doctors providing fake medicine and charging plans is going to hurt patient care. It is those types of things that aren't included but plans are doing and investing significant resources to do so it is not fully capturing the full picture," Zirkelbach says.

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