Pay-For-Quality Pilot Results Show Increased Prevention, Healthier
HealthSpring Inc. has released preliminary results
from its pay-for-quality pilot program showing significant improvements
in quality of care and reductions in emergency room and hospital
admissions and healthcare costs.
"While these are preliminary results, we feel very
encouraged that the numbers show our pay-for-quality pilot has made a
significant impact on care and quality of life for our members,"
HealthSpring Chairman, President and CEO Herb Fritch said. "We are
really starting to see evidence that we’re making headway in
helping to keep our members healthy rather than just reacting once
The pilot covered three states and nine practices
with 87 physicians and 7,468 members in 2007. Duration for the pilot is
three years for one practice and one year for all others.
Preliminary results show improvement in every area
HealthSpring’s pay-for-quality pilot
structures reimbursements for physicians to encourage more extensive
preventive care, rewarding physicians for performing key preventive
screenings and check-ups.
"The focus is on preventing complications and
catching problems before they become serious," said HealthSpring
Medical Director of Quality Dr. William Anderson. "This is a win for
everyone involved. Providers are rewarded for delivering the highest
quality care, members are healthier and enjoy a better quality of life,
and healthcare costs are reduced because the member doesn’t
need treatment for serious complications."
"There has been a lot of talk about
pay-for-performance models recently," Anderson said. "HealthSpring has
been on the leading edge of exploring this concept, and we’re
really seeing positive results. We think these numbers are beginning to
show clearly that healthcare in our country must move towards this type
of model that places the emphasis on wellness and prevention. This fits
perfectly with HealthSpring’s passion for helping members
stay healthy, active and independent long into their lives."
"The success of this pilot also demonstrates the
importance of building relationships with physicians and other
providers," Anderson said. "With our pay- for-quality program,
we’re working together with our providers rather than forcing
something on the physicians that doesn’t work for them.
"We help provide resources the providers need,
such as support for electronic medical record technology or additional
nursing resources to help with more extensive preventive care."
Dr. Sid King, a medical director for HealthSpring
and managing partner for a medical group participating in the pilot,
said he views the partnership aspect of the program as vital.
"It’s this idea of health insurer and provider working
together to keep members healthy that is proving to be so effective."
HealthSpring continues to expand its pay-for-
quality pilot. The program currently includes 27 sites, 348 physicians
and 25,000 members with plans to further expand to a total of 35-40
practices, more than 400 physicians and more than 40,000 members by the
end of the year.
HealthSpring is based in Nashville, Tenn., and its
primary focus is the Medicare Advantage market.
HealthSpring currently owns and operates Medicare
Advantage plans in Alabama, Florida, Illinois, Mississippi, Tennessee
and Texas and also offers a national stand-alone Medicare prescription
drug plan, the company said.
Address: HealthSpring Inc., 44 Vantage Way, Suite
300, Nashville, TN 37228; (615) 291-7000, www.myhealthspring.com.