Highmark Announces Accountable Care Alliance
"For the first time we'll be looking at the overall per capita cost of patient care," said Fiaschetti, who made a point of stating that the program was developed with input from "physicians, not physician administrators."
Fiaschetti noted that the program will reward certain physician behaviors such as spending more time with patients and meeting quality goals.
The physician incentives will be awarded based on enhanced quality and population health management costs. The 28 quality parameters include familiar Healthcare Effectiveness Data and Information Set (HEDIS) and National Quality Forum measures such as tracking that patients receive mammograms at the appropriate stages of their lives and that heart attack patients receive appropriate medications.
Incentives will also be based on follow-up services to make sure patients understand physician orders, fill prescriptions, and take their medications.
For now, the ACA is entirely incentive-based, but plans call for it to grow to a "broader, full gainsharing, risk-sharing model in about three years," said Fiaschetti. "We call it a glide path. You can't just go to full risk and expect physicians, hospitals and specialists to all succeed until we start working together."
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