Title: Pay For Performance: How Will It Work In Real World Practices
1Pay For Performance How Will It Work In Real
World Practices?
William Alexander, M.D. Morehouse School of
Medicine
2Pay 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.
3Provider Quality Initiatives
- Pay for performance
- General performance measurement-report cards
- Accreditation
- Withholds
4Pay 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.
5Pay 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
6Pay For PerformanceStructure
- Financial and non-financial incentives from
health plans, employers, government or healthcare
associations are given to physicians after
meeting certain performance criteria.
7Pay For PerformanceCriteria
- HEDIS measures
- Patient satisfaction
- IT connectivity
- Generic drugs prescription rate
- Cost efficiency
8Ambulatory 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
9Governor 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.
10What 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.
11Bridges 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.
12Bridges 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.
13Physician 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
14Diabetes 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
15Cardiac 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
16Bridges 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
17Bridges To ExcellencePrograms By Site
- Cincinnati- DCL
- Louisville- DCL
- Massachusetts- POL, DCL and CCL
- Albany/Schenectady- POL, DCL and CCL
18Bridges 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
19Pay 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