The Care Focused Purchasing initiative aims within 12 months to use claims, error-rate, and other quality-related data about physicians and hospitals from insurance companies that have agreed to participate in the program.
In recent years, the cost of health care has skyrocketed for employers providing benefits, as well as for workers who shell out higher co-payments and payroll deductions toward their health coverage. Mercer Human Resource Consulting, the project leader for the Care Focused Purchasing initiative, says in a statement that businesses want to use their combined leverage to "create a more open and rational health-care market that resembles markets for other goods and services" that compete on quality and performance. Mercer said the group's aim is to "change the current approach to buying health-care benefits into one that focuses on the quality and efficiency of health-care providers."
Dr. Alan Sokolow, chief medical officer at Empire Blue Cross Blue Shield, says the project is in sync with a trend of more closely monitoring the quality and performance of health-care providers--and giving doctors and hospitals financial incentives to compete on quality. Empire Blue Cross Blue Shield is one of the insurance companies providing claims and quality data for the initiative.
For instance, pilot quality programs are under way by Medicare to analyze quality of care against certain specific benchmarks and to increase reimbursements to health-care providers that achieve the highest measures.
Sokolow says that, in contrast to those other quality programs, the Care Focused Purchasing initiative aims to get that quality information into the hands of consumers who actually chose their care providers. "It's even better [to provide] that information to consumers to help them make better decisions," he says.
Initially, the Care Focused Purchasing initiative will provide quality information to consumers, Sokolow says. However, it's possible the program will evolve so data can be used to financially reward the highest-quality health-care providers with higher reimbursements for care, he says.
Among the employers participating in the initiative are Adecco; Analog Devices; Assurant (formerly Fortis); BellSouth; Capital One Financial; Corning; Edward Jones; Hannaford Brothers; J.C. Penney; Lowe's; Marsh & McLennan, which owns Mercer; Morgan Stanley; the Pepsi Bottling Group; Sears; Sprint; Texas Instruments; VNU; and Xerox. The remaining companies haven't agreed to be publicly identified.
In addition to Empire Blue Cross Blue Shied, Cigna and Humana have agreed to provide data. A spokeswoman for Aetna says it's in discussions to join the initiative.
Mercer says the companies developed the initial project plans in mid-2003 and that the employer group is working with health plans on an "ambitious" list of additional activities for the next 12 months as part of a three- to five-year plan.
Mercer says goals of the project include adopting from existing sources standardized performance measures of quality and efficiency for doctors and hospitals; unlocking "hidden value" in employer, insurance carrier, and government databases by combining detailed information about quality and performance; and sharing provider performance measures with employees and employers.
Work is under way to develop standard fields for the aggregate claims and other data that will be sent by the insurance companies, Sokolow says. He says that data will be stored in a third-party data warehouse for which a vendor has not yet been chosen by Mercer.