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Program Will Combine Medicare, Insurer Claims Data To Accurately Determine Quality, Cost Of Physician Care

Armen Hareyan's picture

Health policy leaders on Wednesday announced a new program that willcombine Medicare and private health insurers' claims data to providemore complete and accurate information on the cost and quality ofphysician care, CQ HealthBeat reports. According to the Robert Wood Johnson Foundation,which announced $16 million in grants for the program over 30 months,"This work represents the first time that data have been aggregatednationally in this way, overcoming one of the major barriers toeffective measurement and reporting."

CQ HealthBeatreports that the grants "will assist the efforts of the QualityAlliance Steering Committee," which aims "to spur the adoption ofconsistent, clear performance measures across the health care system."The Brookings Institution's Engelberg Center for Health Care Reform will receive $8.7 million and the America's Health Insurance Plans Foundation will receive $4.2 million, with about $3 million to be set aside for supplementary activities and other expenses.

The program will be initially based on quality measures established by the National Quality Forum,though it is expected to go beyond those measures eventually. Theprogram also plans to develop with the NQF measures that will allowconsumers to compare providers on cost of treatment for 20 commonmedical conditions, including diabetes and congestive heart failure.

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Informationon physician performance will be distributed through public-private"Value Exchanges" that initially will be set up in 20 to 25communities, according to RWJF Senior Vice President John Lumpkin.

Projectorganizers said physicians will be able to use the data to comparetheir performance with other doctors and to make improvements in care.Consumers initially will be able to compare information only on grouppractices. Participation in the program will be voluntary, but CarolynClancy, co-chair of the steering committee and head of the Agency for Healthcare Research and Quality,said it is possible that insurers would pay lower rates to physicianswho do not submit data. All aspects of the project will be completed by2010, according to program participants.


Mark McClellan -- head of the Engelberg Center, a former CMSadministrator and co-chair of the steering committee -- said theprogram could reduce racial and ethnic health care quality disparities."We're seeing big differences in quality of care across racial andethnic groups," McClellan said, adding, "A critical aspect of thisproject will include identification and measurement of these gaps inorder to help practitioners develop specific interventions that attemptto minimize these differences" (Reichard, CQ HealthBeat, 10/3).

Reprinted with permission from kaisernetwork.org. You can view theentire Kaiser WeeklyHealth Disparities Report,search the archives, and sign up for email delivery at kaisernetwork.org/email. The Kaiser Weekly Health Disparities Report is published for kaisernetwork.org, afree service of The Henry J. Kaiser Family Foundation.