Pay for Performance: Raising the Bar on Quality, Efficiency and Results

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Healthcare Intelligence Network, 2005 - Medical - 65 pages
Pay for Performance (P4P), the burgeoning movement in the healthcare industry to align financial incentives with improved results, is touted as a means of improving healthcare quality without increasing costs. Health plans are now devising metrics for tying millions of dollars in physician bonus incentives to healthcare quality outcomes. In this special report, "Pay for Performance: Raising the Bar on Quality, Efficiency and Results," based on two recent audio conferences, a panel of experts shared their experiences: healthcare consultants analyzed the results of national studies on the reach of P4P programs among U.S.-based health plans and sketched out a timeline for future developments, while three organizations described their ongoing efforts to build cohesive P4P programs. You''ll hear from Geoffrey B. Baker, President, Med-Vantage, Inc.; Dr. Nicholas Bonvicino, Senior Medical Director, Clinical Network Management, Horizon-Blue Cross Blue Shield of New Jersey; Paul Keckley, Executive Director, The Center for Evidence-Based Medicine at Vanderbilt University Medical Center; Dr. Milton Schwarz, Regional Medical Director, Aetna US Healthcare; and Mark Xistris, Director of Provider Relations & Health Information, The Alliance on theories, application and results of pay for performance programs. This report is based on the June 10, 2004 audio conference "Pay for Performance: Improving Clinical and Financial Outcomes" and the September 8, 2004 audio conference "Pay for Performance Measures: Lessons from the Early Adopters" during which Baker, Bonvicino, Keckley, Schwarz and Xistris described the P4P landscape today, the impact of evidence-based medicine on P4P, an employer coalitions experience, how Horizon Blue Cross Blue Shield of New Jersey has revamped their quality improvement program and the fundamentals, metrics and payment details of the Aetna P4P program in California. You''ll get details on: -Trends in P4P; -Getting physician buy-in; -Components of a successful program; -Transitioning P4P programs to an open access environment; -Overcoming the common obstacles to P4P; -Steps in the process of building a performance-based reimbursement (PBR) program; and -What other purchasers are doing. Table of Contents National Update on Pay for Performance -2004 Survey Identifies Five Significant Trends -Ideal Program Scores High on Efficiency and Quality -Medicaid, Self-Insured Jump on P4P Bandwagon -2004 Survey: Participation by Provider Type -Early ROI Evident as Most Markets Enter Phase 2 -Scorecards Show Consumers Quality, Efficiency and Service Grades -Outside Factors Cloud ROI -Early Provider Involvement Boosts Success Rate -Top Ten P4P PitfallsThe Impact of Evidence-Based Medicine on P4P -Defining Evidence-Based Medicine -Common Misconceptions about EBM -Lags in Learning Times Decrease -The EBM Challenge: Timeliness -Media Sways Consumers Interaction with Providers -The Role of Third Parties -Future of Plan Market Consolidation, Consumerism and Competition -Linking Pharmaceutical Costs and P4P -Health Plans and P4P -Emerging Focus of P4P ProgramsPerformance-Based Reimbursement: One Coalitions Experience -Enlisting AHRQ Support for Research -Measuring the Measures -Relating Quality Improvements to Healthcare Costs -Re-admission, Infection Rates Under MicroscopeCrafting a P4P Program California-Style -Key Features of California Effort -Inclusion of Administrative Data Saves Costs, Forces IT Card -Data Collection Overview -Developing a Statistically Viable ScorecardIn Face of Provider Pushback, Horizon Rewards Performance and Efficiency -Program Goals -Quality Scorecards Provide Actionable Information -Catastrophic Detail Report (Horizon BCBS-NJ) -Per Member Per Month Performance of P4P -Evaluating Program Results -Level II Group Financial Results: 2002 PMPM Payout -Success Factors and Future Plans -Fostering Providers Compliance with NIH GuidelinesQ&A: Ask the Experts -Suggestions for Measuring Small Populations -Current Efforts Just the Beginning -Using Financial Incentives to Modify Physician Behavior -Evaluating Risk Adjustment Software -Factoring Provider Interactions in Care Episodes -Weighing the Advantages of Tiered Networks -The Impact of Malpractice on P4P Programs -Formulating a Collaborative Approach to Chronic Disease -Determining Payout Frequency -Data Sources for Advanced Measurements -Measuring the Success of P4P in California -Applying ROI Methodology to P4P Programs -Finding a Champion to Back a P4P Effort -Linking Consumer-Directed Healthcare to P4P -Looking Ahead to P4P in 2005 -Motivating Physicians to Embrace IT -Replicating the Success of the California Endeavor

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