Plan would tie copayments to doctors' rankings

The agency that oversees health insurance for 144,000 state workers wants to launch a program to control runaway healthcare expenses: a ranking of doctors' quality and efficiency that would be tied to lower copayments for patients who seek care from higher-rated doctors.

The Group Insurance Commission this morning will examine proposals it requested from Harvard Pilgrim Healthcare, Tufts Health Plan, Health New England, Fallon Community Health Plan, and other insurance companies. A key feature of each proposal is variable copayments. For example, under the Harvard Pilgrim and Tufts scenarios patients would pay $15 to visit a doctor who is rated highly and $25 to see one with a lower rating.

Dolores L. Mitchell, executive director of the commission, said ranking doctors would be an important step toward making medical care more transparent and keeping premiums down.

''We're saying to our members, these specialty doctors and primary-care physicians represent the best value, and we'll reward you if you use them," Mitchell said.

But many of the state's physicians oppose the idea, saying there is no widely accepted measure of quality care or efficiency. They also warn about the risks of adopting a new program with such a large group of beneficiaries without first conducting pilot studies.

''We don't want people making decisions on their healthcare based on inaccurate or misleading information," said Dr. Alan M. Harvey, a anesthesiologist and president of the Massachusetts Medical Society, a doctors' group. ''If the GIC decides to go ahead without accurate information, that's not fair for patients or physicians."

The move to provide information on individual physicians is another in a series of pioneering steps by the Group Insurance Commission. Two years ago, it required that health companies bidding for its business rank hospitals. The result was Navigator, a Tufts insurance plan that offered varying copayments based on quality rankings. Navigator became so popular that Tufts offered it to other businesses, and the approach has now become widespread. That could also happen with plans that rank individual doctors.

The average health-insurance premium in Massachusetts rose by at least 10 percent in each of the last six years. Employers, politicians, and health insurers are scrambling to slow the rate of increases. That has led to so-called consumer-driven healthcare -- an industry term for plans with high deductibles and copayments intended to make consumers choose medical care based on how it affects their out-of-pocket expenses. Others have pushed to make more pricing information available to consumers.

Barbra G. Rabson, executive director of Massachusetts Health Quality Partners, a group of doctors and healthcare providers that works to improve healthcare quality, said doctor rankings will eventually become common. ''This is going to happen," she said. ''The market is moving in this direction."

Dr. Bruce Landon, associate professor of healthcare policy and medicine at Harvard Medical School, said he has concerns about ranking physicians because the methodology is unproven. But he applauded the Group Insurance Commission's efforts to influence the healthcare market.

''It's good that [Mitchell] and the GIC are trying to stir things up," Landon said. ''We need to be looking for solutions to problems with quality and rising healthcare costs. We're not doing well enough now. And there's potential that consumerism and pay-for-performance will lead to bigger changes."

To rate doctors, the insurance commission performed an analysis comparing similar procedures -- such as treating a broken leg -- to devise a measure of a doctor's cost efficiency. Individual health plans combined those measures with internally developed rankings of doctor quality. The resulting index enabled the plans and the commission to sort doctors into different tiers.

At today's meeting, commissioners will receive a presentation detailing health-plan offerings from several insurers based on its request.

Tufts will propose an incremental approach that extends its Navigator product, but does not directly rate physicians. Instead, doctors in nine surgical specialties would be ranked according to the rating of the hospital with which they are affiliated. Copayments for office visits with physicians in preferred tiers would be $15, and others would be set at $25.

''We're committed to transparency because it achieves not only savings, but improvements in quality," said James Roosevelt Jr., Tufts' chief executive.

Harvard Pilgrim Healthcare would use a computer program to rank physicians in five specialties: cardiology, orthopedics, general surgery, gastroenterology, and dermatology. Copayments to visit preferred physicians would be $15, and $25 to see other doctors.

If other employers ask for a similar approach, Harvard Pilgrim says it will roll out its proposed program, called Independence, to a broader audience beyond state workers and retirees, said Roberta Herman, chief medical officer. ''The employer community is watching this with a lot of interest," said Herman. ''The degree of adoption will depend on the results they see with the GIC."

Bob Carey, director of policy at the Group Insurance Commission, said the copayment differentials are modest.

''These aren't whopping big penalties," he said. ''It's intended to get people to understand there are differences in cost, quality, and efficiency. It's not punitive."

A vote by the commissioners to adopt the plans is scheduled for Feb. 16. If approved, they would be offered to Group Insurance Commission beneficiaries during an open enrollment period in April and May.

Jeffrey Krasner can be reached at krasner@globe.com.