New Program Will Combine Medicare, Commercial Health Insurer Claims Data To More Accurately Determine Quality, Cost Of Physician Care

Main Category: Medicare / Medicaid / SCHIP
Also Included In: Health Insurance / Medical Insurance;  Primary Care / General Practice
Article Date: 05 Oct 2007 - 7:00 PST

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Health policy leaders on Wednesday announced a new program that will combine Medicare and private health insurers' claims data to provide more complete and accurate information on the cost and quality of physician care, CQ HealthBeat reports. According to the Robert Wood Johnson Foundation, which announced $16 million in grants for the program over 30 months, "This work represents the first time that data have been aggregated nationally in this way, overcoming one of the major barriers to effective measurement and reporting."

CQ HealthBeat reports that the grants "will assist the efforts of the Quality Alliance Steering Committee," which aims "to spur the adoption of consistent, clear performance measures across the health care system." The Brookings Institution's Engelberg Center for Health Care Reform will receive $8.7 million and the America's Health Insurance Plans Foundation will receive $4.2 million, with about $3 million to be set aside for supplementary activities and other expenses.

The program initially will be based on quality measures established by the National Quality Forum, though expects to go beyond those measures eventually. The program also plans to develop with the NQF measures that will allow consumers to compare providers on cost of treatment for 20 common medical conditions, including diabetes and congestive heart failure. Information on physician performance will be distributed through public-private "Value Exchanges" that initially will be set up in 20 to 25 communities, according to RWJF Senior Vice President John Lumpkin.

Project organizers said physicians will be able to use the data to compare their performance with other doctors and to make improvements in care. Consumers initially will be able to compare information only on group practices. Participation in the program will be voluntary, but Carolyn Clancy, co-chair of the steering committee and head of the Agency for Healthcare Research and Quality, said it is possible that insurers would pay lower rates to physicians who do not submit data. All aspects of the project will be completed by 2010, according to program participants.

Disparities
Mark McClellan -- head of the Engelberg Center, a former CMS administrator and co-chair of the steering committee -- said the program could reduce racial and ethnic health care quality disparities. "We're seeing big differences in quality of care across racial and ethnic groups," McClellan said, adding, "A critical aspect of this project will include identification and measurement of these gaps in order to help practitioners develop specific interventions that attempt to minimize these differences" (Reichard, CQ HealthBeat, 10/3).

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