An effort to standardize treatment for asthma, backed by Anthem Inc, yielded better care for the patients and higher pay for the doctors at practices associated with Cincinnati Children’s Hospital Medical Center.
Forty-four practices started the initiative in October 2003 to improve care for the nearly 14,000 asthmatic children, representing 35 percent of Greater Cincinnati’s pediatric asthmatic population.
From the start date through November 30, 2006, the percentage of all asthma patients receiving "perfect care" increased to 88% from 4%. Perfect care meant the child’s severity had been classified, a written self-management plan had been provided to the family and preventive medication had been prescribed.
Eleven of the practices received 7%, the maximum, increase from Anthem, the region’s largest insurer, which meant an additional $5,000 to $10,000 per physician, said Kieth Mandel, MD, vice president of medical affairs for the physician-hospital organization at Children’s. Fourteen other practices received 6% hikes.
"Pay-for-performance is a very powerful lever, but in the context of our effort it was one of many improvement initiatives that we leveraged," Mandel said. "There’s a science behind reliability that we’ve learned from non-health-care industries."
The changes led to fewer hospital admissions, emergency room visits and missed school days for children and fewer missed work days for parents. Admissions of Anthem’s 2,000 patients in the groups decreased 14% from 2004 to 2005, while emergency room visits among the Anthem subset dropped 17%.
Anthem’s participation, which had been solicited by the practice groups, ended in December 2005, but the physicians continue the initiative.