Overview of P4P Initiatives and HIT Incentives

1
Overview of P4P Initiatives andHIT Incentives

• Kelly Cronin
• Senior Advisor to the Administrator
• Centers for Medicare and Medicaid Services
• August 2005

2
Why is P4P necessary?

• Physicians and other health care providers want
  to deliver high quality care
• Current FFS system rewards volume of services
  encourages unnecessary and duplicative services
• Payers need to improve the business case to
  realize system level change
• Payment tied to performance means
• HIT infrastructure is necessary to measure and
  report performance
• Providers will be more likely to make investments
  in HIT as products mature to reduce burden of
  data collection and reporting

3
Cross cutting themes for P4P

• CMS-wide
• Medicare Part A and B, Medicaid, SCHIP
• HIT
• Patient centeredness
• Enable evidence based medicine
• Reduce health disparities

4
Foundation of P4P Valid Quality Measures

• Hospital Quality Alliance started with 10
  measures, now 20 are in Hospital Compare
  (www.hospitalcare.hhs.gov)
• Nursing Home Quality Initiative 15 quality
  measures in Minimum Data Set and Nursing Home
  Compare
• Ambulatory Care Quality Alliance 26 primary
  care quality measures

5
What can we implement now?

• Pay for reporting
• Hospital payment update tied to reporting of
  quality measures
• Now being proposed for ambulatory care as first
  step towards p4p
• Claims based approach early on is feasible given
  existing infrastructure

6
How do we get to P4P?

• Need to know how to capture and aggregate data
• Expand the measure set
• Specialty measures
• Efficiency measures
• Pilot p4p leveraging existing efforts to
  establish rules of the road
• Regions where claims data is already aggregated
• Regional health information exchange
• Areas with high EHR adoption rates
• Learn how to combine data from various sources
  (claims, pharmacy, labs)
• Test existing and new ways to get data from
  physician offices (certified EHRs, secure
  network, web-based data collection tools)

7
Interoperable HIT a Key Element of P4P Programs

• Cant fully implement p4p without HIT
• Need incentives for EHR adoption
• Pending changes to Stark and Anti-kickback
• Pay for performance will require investment
  interoperable EHRs
• Enable reporting of data for quality measures
• Certification will ensure needed functionality
  and interoperability
• Leverage health information exchange programs to
  capture and aggregate data for measures

8
Interoperable HIT a Key Element of P4P Programs

• Ensure successful EHR implementation in physician
  offices
• Doctors Office Quality IT (DOQ-IT)
• QIOs assist primary care physicians in selection
  of EHRs
• SOW calls for support for IT implementation in
  primary care practices in each state
• Support re-design of care processes and evidence
  based decision making while reducing
  implementation failure

9
Near term opportunities to define intersection of
P4P and HIT

• AQA pilots over next 6 months leveraging existing
  efforts
• Bridges to Excellence
• MMA 649 demonstration program implemented in 4
  states
• Regional health information exchange programs
  starting in areas with P4P programs