Paying for Performance: Introductory Comments

1
Paying for PerformanceIntroductory Comments

• Carolyn Clancy, M.D.
• Director
• Agency for Healthcare Research and Quality
• October 21, 2004

2
2001 IOM ReportCrossing the Quality Chasm

• There are serious problems in quality
• Between the health care we have and the care we
  could have lies not just a gap but a chasm.
• The problems come from poor systemsNot bad
  people
• Chasm stems from two overarching problems
• How we pay for care
• How we organize and structure care
• Also need improved info. technology

3
AHRQ Role in Measurement and Data for Incentives
Work

• National tracking and benchmarks
• National Healthcare Quality and Disparities
  Reports
• Measuring local experience of care
• CAHPS for plans, hospitals, nursing homes etc.
• Measuring hospital quality and safety
• Inpatient Quality Indicators, Patient Safety
  Indicators
• Measuring potentially avoidable admissions
• Prevention Quality Indicators

4
Growing Private Sector Interest

• Rosenthal et al (Health Affairs 2004) identified
  37 separate incentive plans representing 31
  different payers
• Rewarding Results Demonstrations
• Blue Cross Blue Shield of Michigan
• Blue Cross of California
• Bridges to Excellence
• California Health Care Strategies/Medi-Cal
• Excellus/Rochester IPA
• Integrated Healthcare Association
• Massachusetts Health Plan Quality Partners

5
Framing Observations

• Financial incentives are inherent in any and all
  payment systems.
• It is not a question of incentives vs. no
  incentives.
• Unintended incentives can be as strong as
  intended ones
• Financial incentives are just one force shaping
  quality