P4P and Group IT Investment

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P4P and Group IT Investment

• Douglas Allen, MD., MMM.
• November 18, 2004

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IT Requirements for High Performance

• Get Data
• Lab Values, Rx, Prof Claims, ?Facility Claims
• Therapeutic Class Summary Database
• Extraction of Non-Claims Data
• Chart Abstraction, ?EMR
• Make Data Good
• Dash Board Reports
• Internal Investigative Team to Troubleshoot

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IT Requirements for High Performance

• Use Good Data
• Disease Registries
• Feed Physicians Patient Negative Lists
• Contact Patients Education, Reminders
• High Risk Case Manager Work List
• Physician Specific Performance Measurement
• /- Incentives
• Fed Back Blinded/Unblinded
• Point of Care Support
• Physician Reminders Upon Eligibility Checking
• Lab Values

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The Cost Ladder

Dz Registry Through Vendor
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The Cost Ladder

Patient Negative lists
Dz Registry Through Vendor
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The Cost Ladder


Patient Reminders
Patient Negative lists
Dz Registry Through Vendor
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The Cost Ladder

Internal Data Warehouse

Patient Reminders
Patient Negative lists
Dz Registry Through Vendor
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The Cost Ladder

Dr Financial Incentives
Internal Data Warehouse

Patient Reminders
Patient Negative lists
Dz Registry Through Vendor
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The Cost Ladder

Real Time Decision Support

Dr Financial Incentives
Internal Data Warehouse

Patient Reminders
Patient Negative lists
Dz Registry Through Vendor
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The Cost Ladder
Dz Specific Case Management

Real Time Decision Support

Dr Financial Incentives
Internal Data Warehouse

Patient Reminders
Patient Negative lists
Dz Registry Through Vendor
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Investment Cost Ladder

Electronic Medical Record (Practitioner)
Dz Specific Case Management

Real Time Decision Support

Dr Financial Incentives
Internal Data Warehouse

Patient Reminders
Patient Negative lists
Dz Registry Through Vendor
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Investment Cost Ladder
Electronic Medical Record (Group)

Electronic Medical Record (Practitioner)
Dz Specific Case Management

Real Time Decision Support

Dr Financial Incentives
Internal Data Warehouse

Patient Reminders
Patient Negative lists
Dz Registry Through Vendor
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GNP Performance

• VZV 90th tile
• MMR 85th tile
• Rest of Childhood Imm 60th tile
• Asthma 70th tile
• Breast Cancer 90th tile
• Cervical Screening 90th tile
• Diabetes 90th tile
• LDL 60th tile

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GNP Performance (cont)

• IT Max
• Patient Satisfaction (ave) 64th tile
• State wide, but higher for our region

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P4P (PMPM) to GNP

• HMO P4P Payout PMPM
• Plan 1 0.25
• Plan 2 0.78
• Plan 3 0.94
• Plan 4 1.30
• Plan 5 1.38
• Plan 6 1.89

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What is GNP Investing In?

• Internal CDR Already Developed
• Expanding the Number of Analysts
• Converting SAS to Prof Data Warehouse
• Internet Connectivity for Physicians
• Alone, This Exceeded Full P4P
• Real Time Decision Support

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Too Few For

• Full Time Dz Case Management
• EMR for IPA Physicians
• Intensive Patient Satisfaction Intervention

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Concerns About Future

• No New Money
• Health Plans Bake Into Pricing Model
• Base Increases in Premium ? at Risk
• Including Those Needed to Meet Expenses
• Health Plan Payout Methodology
• Top X Percentile
• Continued Funding
• Guarantees, to Offset Premium Increases

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Possible Solutions

• CAPG Strategy for Transparency
• Publicize Health Plan and Methodology
• CAPG Strategy for Payout Methodology
• Absolute Performance Payout Percentile Payout.
  2 PMPM for P4P Metrics. Separate from Base
  Contract
• ? Isolate the Funds
• Separate Pool
• Paid Directly by Employers