Businesses, insurers do more to improve health care, save money

July 3, 2008 8:52:39 AM PDT
The country's biggest program to pay doctors extra for top-notch, comprehensive care, part of a growing national movement to hold down medical spending by preventing mistakes and complications, is expanding - geographically and in what it tackles. Bridges to Excellence, a nonprofit group, gives doctors annual payments - $50 to $200 per participating patient - for giving effective care and preventing costly complications of diabetes and heart disease. Employers and health insurers underwrite the costs.

This year, Bridges to Excellence will start programs for care of high blood pressure, back pain and depression, plus one evaluating overall care by family doctors. It also added New Jersey, Maryland and the District of Columbia to the 14 states where it operates.

And on Thursday, it launched a new program that could pay doctors up to $100,000 a year for carefully coordinating all care for patients who see multiple doctors.

It's part of a groundswell of huge corporations, coalitions of smaller employers, state and local governments, health foundations, health insurers and a few federal government agencies using financial clout to control health care costs and keep workers healthier.

These projects press hospitals and doctors to adhere to proven quality standards, prevent mistakes and closely oversee patients, particularly those with chronic conditions. They also steer more patients - and sometimes extra money - to the best, most cost-effective providers.

Experts say more than 150 such "pay for performance" programs are slowly improving medical care for millions of Americans and helping employers and other health-care purchasers get their money's worth. Even Medicare has joined in, saying it will stop paying hospitals extra for handling preventable errors and complications, including falls, infections and bed sores that occur in the hospital.

"There's a massive increase in the number of different organizations working on health-care quality," said Karen Linscott, head of one of the biggest efforts, the Leapfrog Group.

FranEcois de Brantes, chief executive of Bridges to Excellence, said the pay-for-performance movement has become huge, but he expects some consolidation to increase impact.

Bridges, launched in 2003, started with programs addressing diabetes and heart disease - two very common, costly conditions - and one called Physician Office Link. That effort rewards doctors who use electronic medical records and other systems to ensure patients get needed follow-up care and counseling.

Their newest program, called "medical home," pays doctors who coordinate care and are certified in Physician Office Link plus two of the five disease management programs.

To earn cash, doctors must get certified by a third-party quality group that evaluates a random sample of the doctor's patient records. Under the diabetes program, just starting in New Jersey, doctors must keep patients' blood sugar, blood pressure and cholesterol levels under control, and document annual checks of eyes and feet for signs of common complications.

Dr. A. O'tayo Lalude, a family doctor in Louisville, Ky., said he gets a total of $1,000 a year for his 10 diabetes patients whose employers participate. As a solo practitioner, he enjoys getting a second opinion on the care he gives.

"I'm pushing them to do things they did not do before," stressing reasons for a careful diet, exercise and taking medications regularly, Lalude said. "My patients do not show up in emergency rooms, they don't have gangrene, they're not blind."

Keith Hawkins, 52, a Louisville mechanic, said Lalude has him get lab tests every eight to 12 weeks and has convinced him of the dangers of not keeping diabetes under control.

"He's done great things to keep me more aware of it, because I was somewhat lax," said Hawkins, who's had no complications.

And because Lalude is certified by Bridges, insurers send him more diabetes patients, making up for the extra recordkeeping and time required.

De Brantes said based on past savings on diabetes patients under Bridges - about $250 each per year, despite extra doctors' visits and tests - getting all 16.5 million diabetic Americans into the program would save about $4 billion a year in avoidable health care costs. In New Jersey, the diabetes program each year could save an estimated $60 million and pay physicians about $10 million.

The Leapfrog Group, founded by Fortune 500 companies with tens of thousands of workers, since 2000 has been pushing hospitals to make changes to save lives and money: having specially trained doctors and nurses in the ICU, adhering to 27 patient safety measures - such as frequent handwashing - and making doctors enter orders in computer systems to prevent mistakes from scribbled prescriptions.

Linscott said the key catalyst for these efforts was the 1999 Institute of Medicine report estimating up to 98,000 Americans a year die in hospitals from preventable errors.

Other groups then started up or expanded, among them the National Business Coalition on Health. Today it includes 60 coalitions of businesses in about 30 states, which together impact the care of about 30 million Americans, said CEO Andrew Webber. His group shares among members successful practices for improving quality and limiting costs, like reducing copayments for patients who stick to their medication and testing schedules.

American Medical Association board of trustees member Dr. James Rohack said savings from better care can take time because doctors often see patients more often at first to get diseases under control.

"It's keeping them out of the emergency room, managing the condition at home, that is the true payoff," he said.