Re “Blue Cross ties its payments to results” (Page A1, March 5): Blue Cross is promoting its Alternative Quality Contract. Who could be against quality? But pull back the curtain, as my primary care colleagues and I have, and there is a distorted sense of quality.

Blue Cross’s measures have little to do with health but everything to do with what can be easily measured. “Quality” means blood pressure, blood sugar, cholesterol numbers. These surrogate measures, not measures of actual health, are co-opted from an unaccountable entity, the Healthcare Effectiveness Data and Information Set, or HEDIS, which was designed to compare HMOs in the 1980s.

This approach does not improve those numbers and, more important, does not improve health. Instead, it encourages overtreatment and undertreatment. My so-called quality incentive is to move a healthy patient’s systolic blood pressure from 141 to 139, thereby crossing the magic 140 threshold, rather than to help someone with a heart attack history improve from 180 to 155. Yet the person with the history of a heart attack would be far more likely to experience a health benefit. Blue Cross doesn’t even measure if people quit smoking as part of these quality incentives.


This notion of quality doesn’t improve people’s suffering or access to timely care. That would be real quality. It’s time Blue Cross responsibly used its outsized influence and listened to patients and the front lines about what quality really means.

Dr. Stephen A. Martin