You’ve got questions, we’ve got answers.
What is QualityPath?
QualityPath is a new way to find and pay for high-quality health care. QualityPath identifies high-quality care; uses new ways to pay for care; and rewards patients who choose that care with lower out-of-pocket costs.
QualityPath‘s innovative approaches include:
- Identifying doctors, hospitals and other facilities that meet or exceed national measures for delivering quality care for selected surgeries and tests. For surgeries, measures are based on the performance of a specific doctor working at a specific hospital.
- Asking designated doctors and facilities to adopt processes that are shown to improve care.
- Requiring providers to adopt decision-support tools system-wide to benefit all patients.
- Focusing on non-emergency surgeries and tests that allow patients to “shop” for care.
- Assisting employers in creating health benefit plans that encourage employees and family members to choose high-quality care.
- Exploring new ways to pay for care, such as bundled payments and warranties.
Why did The Alliance create QualityPath?
The Alliance’s experience shows that measuring the quality of care is an important step toward improving the quality of care. By helping more people select high-quality health care providers, QualityPath can improve health care for everyone.
How was QualityPath developed?
The Alliance gathered information from multiple sources in an inclusive process. Input from clinicians; medical specialty societies; and other purchasers provided valuable insights. Members of The Alliance pledged their support for QualityPath, which helped show hospitals and doctors that employers are committed to changing the way they purchase ‘shoppable’ surgeries and tests to impact quality and cost. The Business Health Care Group, which serves employers in the Milwaukee area, supported the development of QualityPath.
How do hospitals and doctors gain QualityPath designation?
Doctors, hospitals and other facilities can apply to participate each year using a request for proposal (RFP) process. Once they are part of QualityPath, they must complete a “maintenance of designation” application process to continue to participate. Their performance on national quality measures is examined annually as part of this process.
How are applications reviewed?
Identifying information is removed from responses to the request for proposal (RFP). These “de-identified” responses are reviewed separately by the manager of value measurement and a team of medical reviewers from Metastar, a quality improvement organization. Each reviewer scores the responses against a template, determining whether each criterion was met or not. Any scoring differences are discussed and resolved. A summary of the initial review and the de-identified responses are then presented to the full review team for review and discussion. This review team includes:
- The Alliance Manager of Value Measurement
- The Alliance President and CEO
- A physician who serves as The Alliance Health Care Transformation Consultant
- Other physicians or experts as needed
Once decisions are made and evaluations are finalized, the identifying information is restored. The review team holds conference calls with each applicant to discuss evaluation results. Each applicant also receives written feedback, including any gaps that must be closed to fully meet the criteria.
What happens when QualityPath doctors, hospitals or clinics change their status?
Doctors, hospitals or clinics may leave the program if they relocate, choose not to seek maintenance of designation, fail to meet quality standards or are unwilling to negotiate a lower, bundled price. When that occurs, The Alliance works with employers to notify patients of the switch and guide them to another designated provider. You can verify current QualityPath doctors, hospitals and clinics here. Patients can contact the Patient Experience Manager at 800.223.4139 x6607 to learn more. QualityPath designation for surgeries is based on a specific doctor working together with a specific hospital. Together, they must meet national measures of quality and implement processes that have been shown to improve care for patients. Some hospitals that are designated to provide surgeries through QualityPath have only one designated doctor. If that doctor leaves the hospital, then the hospital no longer is designated as a QualityPath provider. To regain its QualityPath designation, the hospital must apply again based on its performance when working with one or more doctors. When a doctor works with a hospital that is already part of QualityPath, the doctor can gain designation when he or she meets the quality criteria. Please note that QualityPath designation does not affect a doctor or hospital’s status as an in-network provider through The Alliance.
Is QualityPath information shared publicly?
The Alliance publicly shares:
- Doctors, hospitals and clinics that are designated to provide care through the QualityPath program for a specific time period.
- Doctors, hospitals and clinics that applied for the program and met the quality criteria, but did not agree to the lower bundled rate with warranty.
- Information about the criteria used for QualityPath
Information about costs for QualityPath surgeries and tests is only available to employers who are members of The Alliance. The Alliance does not release any information about doctors, hospitals or clinics that applied but did not meet QualityPath criteria.
What does “bundling” mean? What is included in a QualityPath bundle?
A bundle is a flat rate that covers multiple elements of a medical test or surgery.
- For surgeries, the QualityPath bundle covers medical procedure costs, which includes the surgery itself, in-hospital care and doctor visits after surgery. Rehabilitation costs may be included, depending on whether the patient chooses to have follow-up services, such as physical therapy, at the QualityPath facility where the surgery was performed. The bundle also applies to care for most complications covered under the warranty offered by the provider for the service or surgery.
- For CTs and MRIs, the QualityPath bundle covers the cost of the test as well as the fees for radiologists who interpret the results.
Do doctors and hospitals who have left the QualityPath program still meet national quality measures?
We annually review the performance of QualityPath doctors and hospitals against national quality measures. Once they leave the program we no longer conduct this review.
Why aren’t there more providers in QualityPath?
QualityPath is a big commitment. To participate, hospitals and clinics must meet quality criteria; take steps that lead to better results for patients; and agree to a lower rate of payment than the average in-network rate for The Alliance. Remember, if everyone could do it, it would represent business-as-usual. Instead, QualityPath is a new and better way to buy health care.
How far do Madison patients have to travel for QualityPath care?
Patients who live in the Madison area have three options for knee and total hip replacements that are within roughly a one-hour drive. The closest provider is Sauk Prairie Healthcare, which has five participating doctors and is located about 40 minutes away. Beloit Health System and Monroe Clinic each have two participating doctors and are about one hour away. (All estimates of travel time are based on a Google search from the Madison city center).
Is it realistic to expect patients to travel for care?
Yes. QualityPath asks everyone involved in the process to do something different – for patients, that means taking a different path to care that might include traveling a reasonable distance. In exchange, patients gain high-quality care and lower out-of-pocket costs, which in some cases means no out-of-pocket costs.
Did The Alliance discontinue its QualityCounts Outpatient and Inpatient reports?
Yes. Information about the quality of health care offered in The Alliance network is instead built into the Find a Doctor website. QualityCounts is now used to highlight our efforts to improve quality for employers and consumers.