Pay for performance
GIC transparency effort lowers co-payments for cheaper health care providers
Five bucks. That’s the typical amount most of the 250,000 residents insured by the GIC will see their office co-payments drop by if they choose a health care provider deemed more cost-efficient by that quasi-public agency.
The program began July 1, but came after more than two years of negotiations and computations with six separate insurers over how to "tier" health care providers, says Dolores L. Mitchell, executive director of the GIC. The agency insures roughly 90 percent of the state’s current and former employees – about 145,000 people and their families.Using data gathered from insurers, the GIC worked with Mercer Human Resource Consulting to build a database comparing the records for all providers in treating a similar ailment. They then compared the costs of that provider’s treatment methods from the beginning of the episode to the end.
The less expensive providers will have lower co-payments, a way to encourage consumers to use the least expensive treatments, Mitchell says.
"A lot of groups are interested in making health care a pay-for-performance type of service and in this case the patient is making that decision," she says. Although the modest difference in co-payments is probably not enough to entice someone to leave a doctor he or she has seen for years, the program is a step in the right direction of making providers look at how cost-effective their care is, she says.
The six insurers administered through by the GIC – including Fallon Community Health Plan, Harvard Pilgrim and Tufts – helped rank their providers into groups with different co-payments. The information gleaned from that database and ranking system is available to consumers who can use it to pick their providers.
"The GIC plan is an innovative one and its move is very significant," says Ric Gross, the New England analyst with HealthLeaders-InterStudy in Nashville, TN. "While there are number of transparency and tiering efforts under way
in various states, the one being implemented by the GIC is the most aggressive. It’s success will be measured in whether it can keep GIC’s premiums down and control skyrocketing healthcare expenses."
Regardless of is outcome, the move makes the Bay State an epicenter in the industry move toward transparency, he says.
Kenneth J. St. Onge can be reach at kstonge@wbjournal.com
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