Minnesota Health Care Group to launch pilot 'pay-for-performance' initiative to reduce treatment costs for depression

The Buyers Health Care Action Group, a health care purchasing coalition in Minnesota for large employers, on Wednesday announced a pay-for-performance pilot program that will reward physicians who effectively treat depressed patients, the St. Paul Pioneer Press reports.

The program will start in 2009 (Forster, St. Paul Pioneer Press, 5/28). The program is modeled after similar pay-for-performance initiatives launched in recent years to improve treatment of diabetes and cardiovascular problems (Lerner, Minneapolis Star Tribune, 5/29). Some of the employers participating in the new program include the state of Minnesota, 3M, Wells Fargo, the University of Minnesota, Target, Medtronic and Carlson (St. Paul Pioneer Press, 5/28).

Under the program, patients will complete a nine-question survey to help primary care physicians determine whether a patient is depressed and gauge the severity of his or her condition. Patients will be reassessed at six months and throughout the course of treatment (Minneapolis Star Tribune, 5/29). The goal of the program is to reduce depression within the first six months and achieve full recovery in one year. Physicians who meet the goal would receive a $100 bonus per patient. Insurance companies participating in the program have committed to paying the bonuses through 2010.

Participating employers also plan to share information next year about which physicians provided the most effective treatment for patients with depression. In addition, the program will evaluate how better depression management affects health care costs (St. Paul Pioneer Press, 5/28). Francois de Brantes -- CEO of Bridges to Excellence, a national pay-for-performance group working with the Minnesota project -- said, "Ultimately, we're not about dictating to physicians how they should practice medicine but rather holding them accountable for the results of how they practice."

Opponents of the initiative say it could have an adverse effect on patient care. Sue Abderholden, executive director of the National Alliance on Mental Illness, said, "Anytime we tie pay for performance to people getting better in terms of a mental illness, I always worry that there's going to be an incentive not to treat the hard-to-treat," adding, "Some people are harder to treat than others. So what happens with those folks?" (Minneapolis Star Tribune, 5/29).