ACOs, Population Health Management Share a Common Thread

With 2010 premium revenue of $150 million, the company has grown considerably and now operates a provider network, administers corporate benefits, and markets healthcare insurance and other ancillary coverage.

"We started out looking at how to help primary care physicians do better in their practices with controlling the downstream costs and to develop pay for performance—and [P4P] has a certain quality to it that's like population health management," he says. "So pay for performance helped our PCPs [primary care physicians] learn to manage their populations."

The initial program has morphed into PHM, says Armstrong. QualChoice now looks at both quality and efficiency measures and establishes targets for physicians treating various patients within the plan, such as diabetics. Physician payments are based on practice results which are scored against the pre-determined metrics. Once all the segments being tracked are scored, they're totaled against a larger dollar target. With an eye on cost reduction, any savings that are shown in the comparison are then shared evenly between the practice and the payer.

"We are focusing on the quality of care, and the metrics help show how we're bringing value," explains Robert Hopkins, Jr., MD, FACP, FAAP, professor of internal medicine and pediatrics at the University of Arkansas for Medical Sciences. The University of Arkansas has been working with QualChoice in hopes of seeing a difference in the community's health through PHM.

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