A coalition of six California health plans has announced its members will soon finish awarding $50 million in pay-for-performance bonuses to physicians groups in the state.
Payment amounts have been determined by the individual plans, but the plans in the Integrated Healthcare Association consortium agreed upon uniform criteria on which the bonus payments should be made: 50% for clinical quality, 40% for patient satisfaction and 10% for adoption of information technology. Participating plans are Aetna, Blue Cross of California, Blue Shield of California, Cigna HealthCare of California, Health Net and PacifiCare.
Tom Williams, executive director of the IHA, based in Walnut Creek, said 215 groups participated in the pay-for-performance program based on clinical data gathered by the plans, with 56 groups augmenting that data with data they gathered and submitted themselves.
According to the IHA, the six plans also paid out another $50 million on their own performance metrics not tied to the uniform IHA criteria.
Williams said the underlying reimbursements for the physician groups come from capitated contracts, and no reduction in capitation occurred to pay for the bonuses. However, in addition to base capitation rates, the contracts had incentive amounts, and "there may be some incentive dollars that are traded off."
He said physician reaction has been mixed. "It depends on how well you did, and how well you did versus you're expectations. Some groups are delighted, others disappointed, and some are in between."
A spokesman for the California Medical Association is troubled that the insurers may be moving money from one physician to another.
"If it's not new money, then it's not a bonus system, it's a penalty system," said the CMA's Peter Warren. "They're all making a lot of money. They're increasing their premiums 10% to 15% over the past few years and paying pennies on the dollar in increases (to physicians) and, in many cases, no money for increases."
But Scott McDermott, CEO of 2,100-physician Hill Physicians Medical Group of San Ramon, Calif., said his group will net $5 million in performance payments based on IHA metrics. McDermott said moving money from one physician to another was "not all bad."
"Doctors or groups who are performing better should get paid more . . . and it's about time," he said.