UnitedHealthcare has agreed to use physician data from the American Gastroenterological Association's Digestive Health Outcomes Registry in its physician performance measurement programs.
The health plan has a "premium designation program" that awards 0-2 stars to physicians based on quality of care and cost efficiency. Under the agreement, cost efficiency would continue to be based on claims data, but quality would be assessed using information reported to the American Gastroenterological Association (AGA) registry.
UnitedHealthcare will begin by testing the process in 20 markets across the country.
The collaboration is good news for gastroenterologists because it means that they can be sure they are being evaluated based on reliable information, said Dr. John I. Allen, AGAF, vice president of the AGA Institute and chair of the AGA Registry Executive Management Board. That’s critical as both public and commercial payers move toward value-based payments, which link quality and resource use to reimbursement.
"Everybody knows that fee-for-service, volume-based reimbursement is probably not the best way to do things. So there has to be some link with outcomes. This is the best effort to try to form a partnership that can develop at least the beginnings of a validated measure set," said Dr. Allen, a gastroenterologist in Minneapolis, Minn. "I think in the long run it will be beneficial."
The AGA registry, which has been up and running for 2 years, uses evidence-based clinical guidelines and outcomes measures developed by GI physicians. The registry is certified by the Centers for Medicare and Medicaid Services, which means that GI physicians enrolled in the registry can use those data to report to Medicare’s Physician Quality Reporting System.
Currently, physicians can use the registry to report data on hepatitis C and inflammatory bowel disease measures.
UnitedHealthcare is the first commercial insurer to partner with the AGA, but Dr. Allen said they probably won’t be the last. AGA officials are in talks with most of the major insurers to see how the AGA’s registry could be used as part of their physician ratings.
Until recently, the physician ratings programs developed by insurers were variable and disjointed, Dr. Allen said. But changes put in place following a 2007 agreement between then-New York Attorney General Andrew Cuomo and several insurers over standards for the ratings systems have helped to make the programs more coordinated. Medicare’s experience operating the Hospital Compare website, which publishes quality information on hospitals, has also added to the knowledge base on quality reporting, he said.
"It’s beginning to get a little bit more organized," Dr. Allen said. "But it’s still difficult."
For its part, the AGA is focused on creating a national performance measure set for gastroenterology that can be used by all payers. The approach, Dr. Allen said, has been to develop a single set of valid measures and go through the endorsement process with the National Quality Forum.