08/05/2007

Associated Press

Five large local companies are embarking on a program to reduce their health care costs while improving medical care for their employees.

Belk, Duke Energy, IBM, Presbyterian Healthcare and Wachovia, as part of the Charlotte Health Care Collaborative, will reward doctors who provide care based on national standards.

Similar programs are being launched around the country, and experts predict that doctors and hospitals will soon be routinely judged on performance measures and paid extra if they can document they've done a good job.

"We're not really rolling this out as a cost-saving program," said Jim Beaver, health benefits manager at Wachovia. "We just want to make sure our employees are getting the best quality care that the community can provide for them."

Payments begin in January. Eligible doctors are recognized by the National Committee on Quality Assurance, a nonprofit group dedicated to improving health care quality.

To qualify, doctors must show they follow NCQA checklists that specify routine treatments and follow-up care that are proven to work for patients with common medical problems, such as heart disease and diabetes.

Average rewards for doctors are expected to be $80 for each diabetes patient and $120 for each heart disease or stroke patient. Annual rewards will range from a few thousand dollars to more than $50,000, based on the experience of Bridges To Excellence, a pilot program started by Verizon, General Electric, IBM and Raytheon in several markets.

Studies of the Bridges to Excellence program show companies saved an average of $225 annually per employee seen by an NCQA-recognized doctor.

More than a year ago, Blue Cross and Blue Shield of North Carolina started a three-year pilot pay-for-performance plan that has paid $800,000 to 135 doctors in 29 practices across the state. Three companies in the Raleigh-Durham area 1/2ndash 3/4 IBM, GlaxoSmithKline and Cisco Systems 1/2ndash 3/4 are also starting a pay-for-performance program.

About 600 N.C. doctors have been recognized by NCQA after proving their treatments follow standards. South Carolina has 42 recognized doctors.

Dr. Bill Sugg, an administrator at Carolinas HealthCare System, said Charlotte hospitals had already begun working on quality improvement before the collaborative formed.

Insurance companies will make reimbursement decisions based on these standards in the future, he said. "We want to get as many of our people qualified as we can."

Businesses in the Charlotte collaborative believe the project will improve care for all patients, not just those who work for their companies. Doctors who follow standards will do so for all patients, said Ches Gwinn, collaborative project manager.

"By increasing the quality of care and lowering the cost, we would hope that over time we would see less of a continual rise in insurance costs. If we can lower the cost of insurance, then more people could be covered.

"Because it's lowering the cost overall, we ought to be able to see more affordable insurance over time. That to me is the real power."

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Information from: The Charlotte Observer, http://www.charlotte.com