Managed care redux

Managed care redux

The Massachusetts Group Insurance Commission (GIC), which has been pushing a quality and efficiency agenda for the state employees it represents, is back in the news with a proposal to introduce variable co-pays based on physicians’ quality and efficiency ratings. (See Plan would tie copayments to doctors’ ratings in the Boston Globe.)

Members would pay a $15 copay for a top-rated provider and $25 for others. Its being touted as a bold new idea, but in its initial design it’s just a wimpy version of an open access network. The relatively weak incentives reflect the fact that the tools and data for measuring quality and efficiency –especially for specialists– are immature. There’s a reasonable chance that if the GIC pushes too hard at this point there will be a major, well deserved backlash.

The move is still significant in two ways:

  • It’s really a trend away from consumer directed care. Rather than consumers reacting to quality ratings of physicians, it’s the health plan that’s doing so
  • It shows that measures that are being collected for pay for performance programs –which can make a few percentage point difference in reimbursement– can also be used to drive market share changes. That has serious implications for physicians and hospitals
January 27, 2006

Leave a Reply

Your email address will not be published. Required fields are marked *