Paying for Performance

1
Paying for Performance
Quality-Based Purchasing and Public Reporting
The Evidence Base and Practical Tools Robert S.
Galvin, MD October 21, 2004
2
The Strategic Fit of Pay-For-Performance
High
Enabled by IT
Quality ? Costs ê
Incentives and Rewards
Clinical Re-engineering by MDs, Hospitals
Suppliers
Value of Health Expenditures
? Market Sensitivity to Hospital/MD Quality Cost
Transparency
Performance Comparisons for Hospitals, MDs Tx
Low
2002
2012
Key Evolutionary Steps
3
Growing Number of Initiatives

• 78 Initiatives
• Easy to Access
• www.leapfroggroup.org
• Commonwealth Fund Sponsored

4
Bridges to Excellence
Diabetes Care Link
Using Evidence-Based Literature and Actuarial
Analysis

• Diabetes
• Quality Care Saves 350/Diabetic/Year
• Purchaser Keeps 175
• Physicians Get 100/Patient Incentives 75

All Payers For Practice with 100 Diabetics -
10,000/Year For Diabetes Clinic with 1,000
Diabetics - 100,000/Year
5
Challenges

• Doctors Signing Up . . . . . . . . But Slowly
• Rewards Being Paid Out . . . .But Not Enough
• Payers Expanding. . . . . . . . . But Not Fast
  Enough
• Patient Incentives Present . . . But Not
  Sufficiently Robust
• Evaluations in Process . . . . . But Business for
  Quality Still Unproven

6
The Leapfrog Model
7
Big Questions

• Funding
• Zero Sum Game
• Sufficient Reward
• Provider Engagement
• Measures
• Professionalism
• Trade Associations
• Equity
• Risk Selection
• Managing to the Measure
• Safety Net Providers
• Leadership