Primary-care doctors who contract with Aetna U.S. Healthcare can earn as much as 25% above their regular capitation rates under the HMO's Quality Care Compensation Program, a profiling method that links performance with cash incentives.
The program offers cash bonuses based on Health Plan Employer Data and Information Set performance data and other "report card" measurements such as the number of preventive screenings and immunizations done by the practice, whether practices offer convenient hours and staff participation in continuing medical education courses.
The company says the program, more than a decade old, was designed to reward quality. Officials said no more than 5% of the bonus is utilization-based but would not provide data on the amount of bonuses paid in 1999.
UnitedHealthcare's profiling program does not yet tie profiles to compensation, but the company says in the future bonus compensation for exceptional scores will be inevitable.
After the second round of its program, completed in August, more than 42,000 doctors in United's clinics were profiled.
United's approach compares medical and pharmaceutical data to provide participating physicians with personalized reports about their current practice patterns in comparison to nationally accepted best practices.
The initial profiles have analyzed six specific areas:
- use of beta blocker drugs to prevent second heart attacks
- mammography rates
- use of ACE inhibitor therapy in people with congestive heart failure
- use of anticoagulant drugs in arterial fibrillation patients
- glycated hemoglobin testing in diabetics
- potassium level screening in people taking diuretics.