Insurer Names METRIC As 'Best Practice Initiative' in Its P4P Program

A Pennsylvania-based insurer has announced that it will accept AAFP's quality improvement initiative known as METRIC -- Measuring, Evaluating and Translating Research Into Care -- as a best practice initiative in its physician pay-for-performance program.

Highmark Blue Cross Blue Shield's decision will give as many as 1,000 Pennsylvania family physicians the opportunity to use METRIC to earn points (five of a possible 115) toward Highmark's QualityBLUE program.

Bruce Bagley, M.D., AAFP's medical director for quality improvement said the Academy has been promoting METRIC to health plans and seeing some interest, but Highmark is the first plan to take action. "With this decision, Highmark has acknowledged that health plans have a role in promoting systematic improvement in office-based care. We believe that many other companies will follow Highmark's lead," he said.

The METRIC initiative was launched in 2005 and was initially designed to help FPs fulfill the requirement for part IV of the American Board of Family Medicine's Maintenance of Certification Program for Family Physicians. METRIC modules currently are available on three clinical topics: diabetes, coronary artery disease and asthma. A fourth module on chronic obstructive pulmonary disease is expected to be available soon on the Academy's Web site.

"METRIC is exactly what insurance companies are looking for," said Bagley. "This program helps family physicians measure and document quality care in an objective way. METRIC users report making permanent changes in their office practices," based on lessons learned while working through the educational program.

John Jordan, EVP of the Pennsylvania AFP, called Highmark's move a "step in the right direction," and he pointed out that it was a step the insurer took voluntarily.

"Highmark should be recognized for its decision," said Jordan. By virtue of that decision, Highmark is acknowledging that the Academy offers members exceptional educational programs that can help physicians improve their practices, he said.

Highmark also has agreed to accept the American Board of Internal Medicine's Maintenance of Certification Practice Improvement Modules, or PIMs, and the National Committee for Quality Assurance Physician Recognition Programs as best practice initiatives that, upon successful completion, would earn physicians the same five points.

Michael Madden, M.D., a medical director in Highmark's quality and medical performance management department, said Highmark's decision just makes good business sense.

"Counting participation in these national programs toward our pay-for-performance program will help streamline our physicians' quality improvement activities," Madden said. "We have the best practice initiative as part of the program, but a lot of the physicians do not know how to do it. They need more educational quality improvement activities than we are able to provide them."

Speaking specifically about METRIC, Madden added, "The AAFP has the resources -- through METRIC -- to meet an educational need of the physicians. We want physicians to succeed. The AAFP gives them a good framework for doing that."