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Reports look at health plans transparency efforts and P4P programs

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Two news items focus on recently published reports on health plans transparency efforts and pay-for-peformance programs.

AHA News focused on a report that examined P4P efforts of 10 large health plans. According to this study (by PriceWaterhouseCoopers), private health insurers are using a wide range of measures and payment incentives in their pay-for-performance programs. Eight health plans had P4P programs for physicians and four had a program for hospitals. The physician programs used nearly 60 performance measures, none of which was common to all of the plans. Payment levels ranged from 1% to 8% of total base physician reimbursement, which most of the insurers deemed too low. The authors of the report state that hospital programs were less evolved and typically negotiated separately with each hospital, but are likely to develop as the Centers for Medicare & Medicaid Services shapes its program.

Business discusses a study of health plans promotion of quality and transparency recently released by the National Business Coalition on Health(NBCH). The report analyzes and compares health plan responses to 19 questions on transparency, health care improvement and technology. According to the report health plans are making progress in promoting health care quality and price transparency and in adopting health information technology, but there is still significant room for improvement.

NCBH report: The eValue8 Cornerstone Report: Measuring the Success of America’s Health Plans

PriceWaterhouseCoopers Health Research Institute report: Keeping Score, A comparison of pay-for-performance programs among commercial insurers

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