Aetna 2005 Annual Report Download - page 33

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29
Furthermore, the experiences of corporations such as General
Motors makes the case that the increasing burden of health care
expenditures for their beneficiaries severely limits their capacity to
compete in a global economy.
In addition to excess cost, there is significant variability in the
quality of health care delivered to individuals in America, with
gaps particularly prevalent among members of racial and ethnic
minority groups. Studies of the relationship of health care costs
and quality indicate that quality of care and spending do not go
hand in hand. Paradoxically, the highest spending often is
associated with low-quality care.2,3,4,5
Faced with these serious and persistent cost and quality problems,
employers, patients and government have called for greater
accountability in health care. In this context, America’s Health
Insurance Plans, a national organization of health plans, has
promulgated a set of guiding principles for establishment
of pay-for-performance initiatives, which can be summarized
as follows:6
■Programs that reward quality performance should promote
medical practice based on scientific evidence and aligned with
the six aims of the Institute of Medicine for advancing
quality (safe, beneficial, timely, patient centered, efficient and
equitable). Research to develop this evidence base is urgently
needed in many areas.
■To be feasible and sustainable, programs that reward quality
performance should involve physicians, hospitals and other
health care professionals in their development. Disclosure
of program methodologies is required to engage these groups.
All key stakeholders must collaborate on a common set of
performance measures.
Value-based
purchasing, or pay
for performance, is
becoming a major
movement in the
American health
care system.
Improve
accountability
Link payment
to quality and
effectiveness