Docs earn extra $54M for quality outcomes

More than 4,000 care providers named winners of PATH program
By Bernie Monegain
10:37 AM
Docs giving thumbs up

Physicians who achieved the highest adherence levels for key quality measures by successfully closing gaps in care when treating UnitedHealthcare Medicare Advantage members, together earned more than $54 million in bonus payments.

The money went to the more than 4,000 care providers named winners of the PATH Excellence in Patient Service Awards.

The PATH program, which is underpinned by health information technology such as CPOE, EHRs, clinical decision support and data analytics, annually rewards physicians who meet certain performance-based criteria, including achieving or exceeding compliance targets for 17 specific measures of the Healthcare Effectiveness Data and Information Set, known as HEDIS.

The measures include the percentages of eligible UnitedHealthcare Medicare Advantage members who received a breast cancer screening or colorectal cancer screening. Other measures evaluate the percentages of members who adhere to their medications to help manage their diabetes, high blood pressure or cholesterol.

[See also: Quality measures 'making a difference'.]

Health plans and the Centers for Medicare & Medicaid Services use HEDIS as a tool to measure performance on important dimensions of healthcare and service.

"We are committed to recognizing and rewarding physicians through the PATH Excellence in Patient Service Awards for consistently helping our plan participants live healthier lives," said Sam Ho, MD, chief medical officer of UnitedHealthcare, in a statement announcing the bonuses. "As UnitedHealthcare continues building deeper, more collaborative relationships with care providers, these awards are an example of how we are supporting the transition to a value-based healthcare system in which payment is increasingly based on ensuring the people we serve receive the quality care they need."

According to the Centers for Disease Control and Prevention, fewer than half of adults ages 65 and older were up to date with core preventive services, such as tests and screenings, despite getting regular check-ups from their doctors. As UnitedHealth executives see it, preventive care becomes even more important with advancing age because many chronic conditions are more common in older adults. Also, preventive care can identify health issues at an early stage, before they have an opportunity to intensify and lead to costly complications that can have a negative impact on people’s quality of life.

The PATH program is designed to encourage greater use of preventive health care services and proactive monitoring of chronic conditions. The program provides support and incentives for both care providers and Medicare Advantage members.

UnitedHealthcare serves nearly one in five Medicare beneficiaries.

[See also: Best practices for quality measurement.]