ACCESS Plus Pay For Performance Program

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ACCESS Plus Pay For Performance Program

• RAC Update March 2009

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Goals of ACCESS Plus

• Improve access to primary care and other
  appropriate health care services
• Provide a medical home for children and adults
• Improve the quality of health care available to
  Medical Assistance recipients
• Provide access to disease management (DM) and
  care coordination
• Stabilize Pennsylvanias Medical Assistance
  spending

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Initial Regression Analysis

• Impact on Financial results
• 823 annual savings per member.
• Evidence of reduced cost among members with PCPs
  engaged in P4P.
• Impact on Utilization results
• Reduction of 38 admissions per 1000 members.
• Analysis less clear on impact on ED visits
  during first year.

4
Initial P4P conclusion

• Not all results attributable to P4P, but strong
  statistical relationship
• Initial program may have included early adopters
• Future assessment will look at both quality and
  cost avoidance

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Expansion of P4P

• Chronic disease
• Pediatric care
• Women's health
• Maternity care
• Access to care

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Pay For PerformanceDiabetes Measures
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Pay For PerformanceDiabetes Measures
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Interim P4P Review

• Over 1,600 Providers participating (as of Dec 1
  2008)
• Approx. 3.2M in incentives to enrolled Providers
  (Program to date).
• These dollars are over and above standard fees
  paid for services as determined by OMAP
• Participating offices care for gt15,000 DM
  patients
• gt7,000 (50) of the high risk patients

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Conclusions

• Clinical quality improved
• DM program provided cost savings
• Members receiving care from providers engaged
  in P4P program had reduced inpatient admissions
  and overall PMPM costs