Pay for Performance: Have Expectations Exceeded Outcomes

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 Pay for PerformanceHave Expectations
Exceeded Outcomes?
A Review of National Trends and Future
Directions
Geof Baker, Principal Venture Advisory Services
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Agenda
National Context
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P4P Market Adoption Has Matured
Source Med-Vantage-Leapfrog 2006 National
Survey with 2007 Market Updates Note For
Other in 2007, included disease management
programs and vendors with P4P incentives under
the primary program sponsor (Medicaid) and 10
projected implementations .
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P4P Incentives Extend to All Providers
Source Med-Vantage-Leapfrog 2006 National
Survey with 2007 Market Updates
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The P4P Evolution Roadmap
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The P4P Evolution Roadmap
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P4P Complements Other Initiatives
Pay for Performance
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Reasons for Implementing P4P Programs
Using a scale from 1-5, where 1 equals NOT
important and 5 equals VERY important
Source 2007 Med-Vantage/Leapfrog P4P Survey
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Findings Lessons Learned
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Inherent Limitations .But Here to Stay
Rewards Integrated with Other Initiatives
Insufficient Motivation
P4P payments gt 10, frequency to reinforce change
All payer aggregated data, uniform platforms
with regional exchanges to increase sample size
Outcomes/composite measures, opportunity areas,
CQI culture, engage MDs, assisted interventions
Exception reporting, risk adjustment
Some gains, few wind-ups, requires iterations
reengineering, cost of care/outcome measures
ROI Unknown
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Many Use P4P as a Strategy to Achieve Change
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Inherent Limitations .But Here to Stay
Uniform measure sets, coordinated programs, HIT
Relative improvement payout models
Demographic adjustment required
Patient Accountability
Value based benefit design, patient health rewards
Quarterly reporting, point-of-care interventions
Single Source of Truth
Data integrity, patient attribution, standards,
clinical data exchanges, direct data submission,
chart data
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Data Submission Integrity

• Direct data submission (supplement claims with
  collection of clinical values from registries or
  EHRs, lab)
• Multiple submission methods (secure sign-on,
  electronic)
• Standardized data field definitions
• All payer aggregation of admin data (claims, rx)
• Immediate validation / integrity checks
• Auditing and QA (correct coding)
• Help desk and training support,
• Models IHA, MHQP, BTE, MN, BQI / Charter Value
  Exchange
• Multiple attribution models - what are the
  intended purposes?

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Next Generation Release 3.0
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Anticipated Changes in P4P Programs
Data Aggregation Participation in state-wide,
collaborative quality initiatives
Source Med-Vantage-Leapfrog, 2006 National
Survey with 2007 Market Updates
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Road Ahead Key Trends for P4P

• CMS is now in business, More to incent
  sustained change
• Strategy to achieve change and sustain CQI
• Going beyond process measures with diminishing
  returns - Clinical measure impact must be
  demonstrable and focused
• Integration with other initiatives - HIT adoption
  (ERx), Medical Home, Cost of Care (Are we
  reducing trends yet?), Health Rewards
• Methodology full disclosure open standards
  (nyrxreport.ncqa.org)
• Physicians acting upon actionable information
  at point-of-care
• Data aggregation, clinical exchange, clinical
  values, enhanced collection
• Strong push for transparency