Pay For Performance: How Will It Work In Real World Practices

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Pay For Performance How Will It Work In Real
World Practices?
William Alexander, M.D. Morehouse School of
Medicine
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Pay For PerformanceEducational Objectives

• Describe the driving forces behind P4P in
  healthcare today.
• Understand the potential impact of P4P on
  improving healthcare quality.
• Understand the potential impact of P4P on
  clinical practice.

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Provider Quality Initiatives

• Pay for performance
• General performance measurement-report cards
• Accreditation
• Withholds

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Pay For PerformanceBackground

• Evaluation of physician performance is not new.
• Health plans have been doing it for many years.
• Consumer-centered media have looked at
  non-clinical measures as proxies for clinical
  quality.
• Currently there are more than 80 P4P programs
  nationwide.

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Pay For PerformanceWhats Driving The Current
Movement?

• Medical cost inflation
• IOM report-Crossing the Quality Chasm A New
  Health System for the 21st Century
• Consumer driven health care
• P4P can be a major driver of health reform

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Pay For PerformanceStructure

• Financial and non-financial incentives from
  health plans, employers, government or healthcare
  associations are given to physicians after
  meeting certain performance criteria.

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Pay For PerformanceCriteria

• HEDIS measures
• Patient satisfaction
• IT connectivity
• Generic drugs prescription rate
• Cost efficiency

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Ambulatory Care Quality Alliance

• A coalition of clinicians, health plans and
  government officials
• The Alliance agreed on twenty-six quality
  measures for physician offices to be used to set
  up performance based payments beginning in 2006
• The twenty-six measures address prevention, CAD,
  CHF, DM, asthma, depression, prenatal care and
  overuse/misuse

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Governor Perdue Hosts Speaker Gingrich to Launch
Georgia Diabetes and Obesity Project

• On September 9th Governor Perdue hosted a
  breakfast that launched the Healthy Georgia
  Diabetes and Obesity Project sponsored by the
  Center for Health Transformation.
• Employers, health plans and physicians are
  working with the Center to launch the largest
  Bridges to Excellence program in the country as
  the cornerstone of the project.

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What is Bridges To Excellence? (BTE)

• BTE is a multi-state and multi-employer coalition
  whose mission is to reward healthcare system
  quality through rewards and incentives.
• The incentives focus on providers and patients.
• The provider incentive program encourages,
  recognizes, and rewards providers for delivering
  optimal care.

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Bridges To Excellence

• BTE has three key programs that address diabetes
  care, cardiac care and office practices.
• Program costs are usually paid by the
  participating employers for their employees.
• BTE is up and running in Cincinnati, Louisville,
  Massachusetts and Upstate New York.

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Bridges To ExcellencePrograms

• Physician Office Link (POL)- Promotes office
  practice use of information to improve patient
  care.
• Diabetes Care Link (DCL)- Promotes improvement of
  the quality of care diabetes patients receive.
• Cardiac Care Link (CCL)- Promotes improvement of
  the quality of care patients with cardiovascular
  disease receive.

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Physician Office Link

• 3-year recognition in NCQAs Physician Practice
  Connections Program
• Office practices must submit data in three
  categories clinical information systems. patient
  education and support and care management

• Maximum 50 per eligible member of participating
  employers
• To earn 50 reward, practices must pass at least
  one module in each category in Year 1, at least 2
  per category in Year 2 and all 3 modules in each
  category in Year 3

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Diabetes Care Link

• 3-year recognition in NCQAs Diabetes Physician
  Recognition Program
• Physicians must submit data on HbA1c control, BP
  control, cholesterol testing and control, eye
  exam, foot exam, nephropathy assessment and
  smoking status/cessation advice or treatment for
  a sample of their diabetes patients
• 80 per eligible diabetic patient of
  participating employers

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Cardiac Care Link

• 3-year recognition in NCQAs Heart/Stroke
  Recognition Program
• Physicians must submit data on BP control,
  cholesterol testing and control,
  aspirin/anti-thrombotic use and smoking
  status/cessation advice/treatment for a sample of
  their cardiac/stroke patients

• Maximum 160 per eligible cardiac patient of
  participating employers
• Physicians who earn recognition will receive 80
  per eligible cardiac/stroke patient
• Physicians who earn top scores will receive an
  additional 80 per eligible cardiac/stroke patient

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Bridges To Excellence Results

• NCQA/ADA Diabetes Physician Recognition Program
  (DPRP) practitioners improved diabetes care they
  provided 50 percent over seven years
• Three recent studies by national health plans
  found that BTE DCL participating physicians
  provided care that was significantly more
  consistent with best practice guidelines
• DPRP physicians provided care that cost 10 to 15
  percent less than non-DPRP physicians
• The majority of the savings came from fewer ER
  visits and hospitalizations

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Bridges To ExcellencePrograms By Site

• Cincinnati- DCL
• Louisville- DCL
• Massachusetts- POL, DCL and CCL
• Albany/Schenectady- POL, DCL and CCL

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Bridges To ExcellenceProgram Expansion

• Medicare- POL addition to forthcoming Medicare
  Management Performance Demonstration Project in
  Arkansas, CA, Utah and MA
• Business coalitions- Illinois (2), Colorado and
  Arkansas. All are members of the National
  Business Coalition on Health
• Large national plans- United, CIGNA
• Care First Blue Cross Blue Shield
• Georgia-statewide focus on diabetes

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Pay For PerformanceImpact on Clinical Practice

• Will impact reimbursement as incentives become a
  more important part of total compensation
• Will drive clinical quality improvement
• Will drive more information technology into the
  health care system