Some Insurers Measuring Physicians' Fees, Quality To Determine Costs,
Health Plan Members' Share of Payment - 07/04/05
The
AP/Detroit News on Friday examined some health insurers' offering of
tiered health plans that base member copayments on health care providers'
quality and cost information. Under such plans, member copayments are highest
for physicians and hospitals that health insurers say provide more costly care.
According to the AP/News, UnitedHealth Group and Medica have begun pilot
programs in which members who see a doctor not included in the preferred tier
pay between 10% and 30% of the cost of services. Tiered plans are marketed as a
"cost-saver" to employers, who typically pay a greater share of health insurance
premiums. However, tiered plans "are already raising anger and concerns among
health care providers and patients," the AP/News reports. Doctors
critical of tiered plans say that quality care could be compromised if doctors
are sorted based on the cost of treatment. In addition, some hospital systems
have said they will eliminate contracts with health insurers unless the tiered
plans are revised, and some patients have voiced opposition to plans that have
required them to change physicians to avoid higher copays, the AP/News
reports. Al Eldendary, president of the St. Louis Metropolitan Medical Society,
questioned insurers' ranking methods, saying UnitedHealth's system uses billing
records instead of medical records and the data is inaccurate. Lewis Sandy, head
of clinical strategy at UnitedHealthcare, emphasized the quality-ranking system
of the plans, based on claims and survey data, but acknowledged that some
doctors receive a lower ranking because of cost.