WORCESTER At a time when most health care organizations are struggling to keep up with the changes sweeping the industry, Reliant Medical Group stands out in one important way.

At Reliant, a Central Massachusetts-based doctors' group, nearly three-quarters of the 180,000 patients are covered by health plans that, to some level, reward doctors for keeping patients healthy and penalize them with lower payments when the quality of care falls.

These plans pay doctors a set amount of money to care for each patient. They encourage primary care physicians to make sure their patients are getting regular checkups and screenings, so illness doesn't grow undetected. They are alternatives to the long-ingrained fee-for-service method of payment, which compensates for the quantity of care over the quality.

Now in an effort to slash costs, improve quality, cut waste and comply with new state and federal laws, the health care industry is moving to these types of alternative payment plans. But few have embraced payment reform to the extent Reliant has.

Systems and millions

A report released this year by the state's Center for Health Information and Analysis said 61 percent of the commercial health insurance market in Massachusetts is fee-for-service. At UMass Memorial Health Care, the biggest hospital system in Central Massachusetts, an overwhelming 95 percent of payments are fee-for-service. At Reliant, that figure is around 25 percent.

Reliant's outlier status can be traced back to its history, when it was called Fallon Clinic and was part of a system that included an insurer, Fallon Community Health Plan, and a hospital, St. Vincent. Fallon Clinic, later renamed Reliant, continued to focus on what are known as global or capitated payment models, even after separating from the health plan and hospital.

"You have to have the systems in place," said Dr. Armin Ernst, president and chief executive of Reliant. "It takes many years to build that."

It also takes many millions of dollars. Reliant spent $24 million to roll out its Epic electronic health record system and has 24 full-time employees dedicated to operating it. The group also has 59 data analysts, many dedicated to monitoring patient data.

Technology, analysis

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Health care fees are shifting gears