Physician Tiering Catching On (fall 2008)
Physician tiering as a means to improve health care quality while reducing costs (similar to the GIC's Clinical Performance Improvement Initiative) is beginning to be adopted by other purchasers and providers of health insurance. Through these programs, members pay lower co-pays when they visit better performing physicians, and in some plans, hospitals.
The GIC’s Select & Save non-Medicare plans tier physicians based on quality and cost-efficiency.
***Tier 1 (excellent)
**Tier 2 (good)
*Tier 3 (standard)
With the GIC’s plans, members pay lower office visit co-pays for physicians who meet quality and cost efficiency standards. Physicians for whom there is not enough data and non-tiered specialists are assigned the Plan’s Tier 2 co-pay. Co-pays vary by health plan; physician tiering details can be found on the plan’s websites or by calling the plans.
Similar non-GIC initiatives include:
Minnesota State Employee Group “Advantage Health Plan”: Unlike the GIC’s program, this plan focuses only on cost; it does not include quality although quality information is provided with links to Minnesota Community Measurement. Members who have completed a health risk assessment during open enrollment have the following physician office visit co-pays (co-pays are higher for members who have not completed this assessment): $17 (level 1), $22 (level 2), $27 (level 3) and $37 (level 4). Inpatient hospital co-pays are $85, $180, or $450 and 25% coinsurance respectively.
Blue Cross Blue Shield of Massachusetts Network Blue Options (PPO and HMO): These plans tier Primary Care Physicians with co-pays of $10 (enhanced tier), $15 (standard tier) and $20 (basic tier), with the tiers connoting that the providers meet the plan’s quality and low cost benchmarks, meet quality and moderate cost benchmarks, or are below quality and/or cost benchmarks, respectively. All specialist office visits have a flat $25 co-pay per visit. The plan also tiers inpatient hospital care at $200 (enhanced tier) or $400 (standard or basic tier).
Aetna Aexcel®: This plan, offered in selected U.S. markets, tiers 12 medical specialties according to the plan’s clinical performance and efficiency standards. Aetna used their own data to evaluate selected specialists. Physicians are either Aexcel®-designated, or they are not.
This information provided by the Group Insurance Commission.