Health Insurance Company Quality Bonuses

Insurance Company Bonuses for Quality from the Care National Blog http://carenational.com/ 


"Just how much money are we talking about? She explained that for a health plan with just 100,000 members being evaluated by HEDIS, each quality measure would mean around $17 million in reimbursements from federal or state agencies. When you consider that there are 20-25 measures directly tied to reimbursement (depending on the health plan and the population served) the math adds up to $340 – $425 million in revenue each year! Now consider what that might look like for larger Managed Care Organizations who have a million or more members enrolled. “You are not talking about a little bit of money. You are talking about what keeps the machine running – literally!” In addition to standard reimbursement, CMS Stars ratings are directly related to the percentage of HEDIS measures met. That also translates to losses or gains in revenue as Stars ratings are something the public is very aware of when shopping for a health plan. Ultimately, if a health plan demonstrates poor performance for 3 or more years, CMS will assess penalties against them, up to and including shutting the organization down. Having key leaders that internalize the monetary value of each measure, and the importance of HEDIS as a whole, generally transforms the whole company’s understanding of the importance of those quality measures, such as preventative care, safety, patient satisfaction, and provider satisfaction. That is the fundamental concept behind any Pay for Performance (P4P) quality initiative."