Tuesday, March 29, 2005 Health Care Marketplace
The Wall Street Journal on Tuesday examined a multistate UnitedHealthcare program that allows employers to provide financial incentives to employees who visit physicians from a list selected by the company based on their ability to provide efficient and cost-effective care. According to the Journal, the UnitedHealth Performance Designation Program "is part of a broader effort by insurers and employers to curb rising health care costs." About 25% of physicians in the larger UnitedHealthcare network are included in the program, through which employers -- such as General Motors, DaimlerChrysler and UPS -- can offer employees incentives like lower copayments to visit physicians on the selected list. Some physician groups, such as the American Medical Association and the Medical Group Management Association, have said that the criteria used by UnitedHealthcare to select physicians for the program -- which ranks them based on analysis of insurance claims from 2002 and 2003 -- is imprecise and exclusionary. Physician groups also maintain that UnitedHealthcare excludes certain specialists from the program because no evidence-based criteria to evaluate their performance exist and that the program leads to "administrative confusion within practices," the Journal reports. According to UnitedHealthcare officials, selection of physicians for the program is based on a "thick book" of evidence-based criteria, which include clinical studies and scientific research. UnitedHealthcare also maintains that a small number of physicians "have been evaluated solely on cost" and that others were excluded from the program because they "hadn't submitted a sufficient number of claims in the two-year period to analyze," the Journal reports. Physician Groups Call for End to Program
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