America’s Health Insurance Plans say that innovative payment models implemented by health plans nationwide to reward quality and spur improvement have improved the health care market and are an essential component to comprehensive reform.

The group’s new publication “Innovations in Recognizing and Rewarding Quality,” details measurable results from health plan payment models that are reducing costs, enhancing quality and improving patient satisfaction, AHIP said.

The report comes as Congress considers various proposals to reform the health care system and AHIP is encouraging policymakers “to consider the next generation of delivery system reforms that are currently underway in the private market and that have yet to take hold in public programs,” the group said.

AHIP is a national association representing nearly 1,300 member companies providing health insurance coverage to more than 200 million Americans. The AHIP report highlights what it calls “some of the most innovative approaches that plans have taken to recognize and reward physicians and hospitals for achieving national benchmarks, demonstrating outstanding performance, and making measureable improvements over time.”

Karen Ignagni

Karen Ignagni, the president and CEO of AHIP, said there is “widespread agreement” that delivery system reforms are needed to not only improve patient care, but also make health care more affordable.

“Health plans are pioneering the types of innovative approaches necessary to move to a 21st century, evidenced-based health care system,” she said in a statement.

A 2006 New England Journal of Medicine article reported that at least half of the nation’s health plans, representing 80% of enrollees in such plans, included some pay-for-performance incentives in their provider contracts.  Physicians and hospitals are evaluated on a variety of measures, including clinical quality, patient satisfaction, utilization of services, and business practices.  These payment models have been developed in close collaboration with participating physicians and other stakeholders.

The new AHIP publication highlights measureable results that health plan pay-for-performance programs have achieved, including: more patients getting recommended treatment following hospitalization; reduction in emergency room visits; increased generic prescribing rate; and greater adoption of new technologies, such as electronic medical records, e-prescribing, and patient registries.

Steven Udvarhelyi, senior vice president and chief medical officer at Philadelphia-based Independence Blue Cross, said “there is still wide variation across the country in how physicians practice and what care they give, and, as a result, research shows that Americans continue to spend significant health care resources on inappropriate and unnecessary care.”

He noted that poor performance in the U.S. health care system costs the nation up to 79,000 avoidable deaths, 66.5 million sick days, and $1.8 billion in excess medical costs each year.

AHIP member companies offer medical insurance, long-term care insurance, disability income insurance, dental insurance, supplemental insurance, stop-loss insurance and reinsurance to consumers, employers and public purchasers.