The South Hills practice could implement the pilot in part because of the same quality-improvement personnel who guided its previous efforts. Most primary care practices lack this infrastructure and they aren't being paid to create it. At the South Hills practice, DeGregorio and three staff members spend much of their time working on quality projects, which rely on timely audits of medical charts that evaluate how well doctors are doing. Initially, Highmark Blue Cross Blue Shield provided some funding for these efforts and the doctors themselves have dedicated money to the project that would otherwise be income. But in the long run, it's unclear how the projects will be funded, DeGregorio said.
Many health plans provide information to doctors about quality of care.
That's because HMOs are rated by a national accrediting group on the quality of preventive medicine plan members receive. The doctors at the South Hills practice welcome the help, but they believe physicians respond best to data and guidelines that they themselves generate.