To develop the rating system used on the Care Focused Purchasing cards, the group of employers plan on using claims data provided by insurance companies to measure physicians against generally accepted quality standards. The 28 large companies – which includes Sprint Corp, Lowe’s Cos, BellSouth Corp and Morgan Stanley – collectively cover two million employees and their dependants, according to a New York Times report.
The conglomerate, working in conjunction with Mercer Human Resource Consulting, plans to have a scorecard product in place that would use an “easy-to-understand” system of points or stars within a year. To promote the use of the scorecard, employees also plan on using an incentive program for employees, such as lower co-pays or deductibles that choose the best providers on quality and cost.
Doctors though are not sold on the idea. Measures of quality, some doctors point out, might not take into account factors such as whether physicians are generally treating sicker patients with multiple chronic conditions whose outcomes may not look good even if they are providing excellent care. Also, the doctors caution claims data will not take into account how well a doctor communicates or relates to patients.
Further concerns are raised about the agglomeration of data, specifically persuading a wide swath of insurers to provide data, to ensure statistically solid samplings and useful, accurate ratings. So far, the group has commitments from Humana Inc, Cigna Corp and Empire Blue Cross Blue Shield to contribute their data. Additionally, the group is in discussion with Aetna Inc , which has its own pilot ” Aexcel ” network in three cities rating doctors in six medical specialties.
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