UnitedHealth forces pay-for-performance measures in new contract

By Bruce Japsen | Tribune staff reporter
Chicago Tribune

An end to a rift that began almost four years ago between Advocate Health Care and managed-care giant UnitedHealth Group over payment rates will result in new pay-for-performance measures for Advocate doctors under a new contract announced last week by the insurer and the Chicago area’s largest provider of medical care.

The good news for more than 900,000 people insured by Minneapolis-based United’s health insurance plans is that they will be able to access and have medical coverage at Advocate’s hospitals and affiliated physicians. The deal means Advocate providers will be in United’s network of providers effective Dec. 1.

And for the first time, Advocate physicians who contract with health insurers through Advocate Physician Partners will be held to certain performance measures, an increasing trend in U.S. medical care that sets up various quality standards for doctors to meet in order to get increased payments or bonuses.

“We have agreed upon a set of measures that will collectively work toward and exchange information on,” said Tom Wiffler, president and chief executive officer of UnitedHealth Group’s United Healthcare of Illinois Inc. subsidiary. “It’s all in the interest of driving toward a more quality-based system and driving affordability at the same time.”

Specific terms of the contract or payment rates were not disclosed. The pay-for-performance measures were a key reason talks between United and Advocate broke down four years ago, Advocate said.

The measures are actually Advocate measures that “overlap” with United measures used in other markets that are based on various national quality standards, said Dr. Lee Sacks, president of Advocate Physician Partners.

They include 50 some measures in 30 different disease areas, Sacks said. For example, doctors that provide control of their patients’ diabetes and cholesterol and keep patients with asthma out of hospital emergency rooms can quality for a payment incentive, Advocate said.

Sacks said they try to make the quality measures “relevant” to “demonstrate we are improving outcomes and creating value.”

Four years ago, the rift between Advocate and United was one of the Chicago-area’s most high-profile disputes between a medical-care provider and an insurance company and caused an undisclosed number of people to choose new doctors and hospitals to choose new providers in United’s networks or switch insurance companies to maintain access to Advocate providers.

The contract covers Advocate’s eight Chicago area hospitals and 800 employed physicians in the Advocate Medical Group, Advocate Health Centers and Dreyer Clinic and hundreds of independent physician members of Advocate Physician Partners, which is a joint venture between the doctors and Advocate Health Care.
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