Satisfying the varied quality metrics of private insurers can pose major clinical and administrative challenges for hospitals. But Advocate Health System, a 12-hospital system based in Chicago with 3,800 employed physicians, has avoided that quandary by persuading its insurers to judge its performance, and that of its employed and affiliated physicians, on one set of metrics developed by Advocate.
Starting with 36 measures in 2004, Advocate has rewarded its affiliated and employed physicians for performance and adherence to the standards via a clinical integration incentive fund to which most of its insurers contribute. Each physician receives compensation related to both his or her own performance as well as the overall performance of other members of the physician-hospital organization. Today, Advocate has roughly 150 measures in place; its incentive payouts to clinicians have grown from $12.4 million in 2005 to $50 million last year.
Mark Shields, M.D., senior medical director for Advocate Physician Partners, the system's care management venture with its employed physicians, says Advocate was able to convince its insurers that the use of a standard set of measures would engage and motivate physicians and other clinicians.
"Having a consistent set of measures has to be in the context of … an overall contract approach for clinical integration," Shields says.
Marty Manning, president of Advocate Physician Partners, says the system meets yearly with its insurers to make sure its quality measures are in line with the payers' own areas of interest.
"We try to keep those discussions very candid and honest," Manning says.
Steve Hamman, vice president for network management at Blue Cross Blue Shield of Illinois, says the measures align well with the insurer's decade-old clinical quality efforts. Blue Cross Blue Shield uses Advocate's measures to evaluate its performance, but does not participate in the physician incentive program.
In turn, Hamman says, the Blues' quality program is designed to align with similar efforts by the Centers for Medicare & Medicaid Services. By leveraging the market share of both CMS and Blue Cross, Hamman says he hopes clinical integration models similar to Advocate's approach can serve as a "tipping point" for other payers to embrace a standard set of industry measures.
"We would love to get standardized quality metrics in place across all payers," Hamman says. "We are trying a standard that aligns with CMS and hoping that other payers see it that way."
Advocate mulls federal ACO participation, praises quality measures
Advocate Health System currently is under contract with Blue Cross Blue Shield of Illinois to create a formal accountable care organization, but as of press time, the system has not yet decided whether to participate in the Centers for Medicare & Medicaid Services ACO initiative, which begins Jan. 1, 2012. Marty Manning, president of Advocate Physician Partners, says the system and its physicians have embraced the accountable care model, but have not decided whether the federal program is a good fit for the system.
Regardless of whether Advocate participates in the CMS program, Mark Shields, M.D., senior medical director for Advocate Physician Partners, says the initiative's quality measures have a promising future. While noting that participants will have difficulty meeting all 65 quality measures included in the first year of the program, Shields argues that the standards may emerge as a measuring stick for all providers.
"I think it's going to become the industry standard for measures," Shields says. "Out of those 65, having a subset can be a way to begin to move down the road of clinical integration. … We can quibble about individual measures, but certainly the general thrust is a very strong one."