APRIL 19, 2012

Welcome to the Pay for Performance Update eNewsletter
This issue sponsored by the Pay for Performance Summit

The Long-Term Effect of Premier Pay for Performance on Patient Outcomes
Researchers from the Harvard School of Public Health reporting on their study of Premier's HQID Demonstration Project with CMS found little support for concluding that participation in the program led to lower 30-day mortality rates. The authors suggest low expectations for efforts employing a similar mix of incentives and targets. (NEJM March 28, 2012)

Medicare's Flagship Test of Pay-for-Performance Did Not Spur More Rapid Quality Improvement among Low-Performing Hospitals
In a related story, other researchers report in this Health Affairs article on Premier's HQID Demonstration Project with CMS that they found no evidence of improvements in mortality and that changes made to the program's incentives in 2006 had little effect. They also found that no improvements were seen in the group of lowest performing hospitals, the group for which the program was intended to provide strong incentives. The findings "cast some doubt" on hospitals' ability to respond to economic improvement incentives. (Health Affairs, April 2012)

Incentivizing Quality Care through Pay-for-Performance
The effort to change payment models by introducing quality incentives is an international one. Britain's Quality and Outcomes Framework (QOF) is an example to note. The QOF began in 2004 as a result of negotiations between the government and British general practitioners. Interestingly, the program was intended to increase healthcare spending which was considered to be too low in the U.K. Covering 134 targets, resulting compensation payments can total as much as 25% of a GP's income. "In its first few years, the QOF appears to have led to improvements in aspects of quality targeted by the program, particularly on process measures. Improvement was especially strong among poorly performing practices..." (Commonwealth Fund, April 5, 2012)

Medicare to Tie Doctors' Pay to Quality, Cost of Care
CMS is struggling with how to define and quantify physicians' performance in order to implement the ACA-mandated Physician Value-Based Payment Modifier in 2015. According to the law, bonuses and penalties in 2015 are to be based upon 2013 results. The first CMS "resource reports" were released to 20,000 Midwest physicians in March. It is likely that the methodology employed will find its way into private payer strategies in the future. (Kaiser Health News, April 15, 2012)

Pay-For-Performance Programs to Reduce Racial/Ethnic Disparities: What Might Different Designs Achieve?
Analyzing scores from the Hospital Quality Alliance, researchers found P4P programs resulted in a small decrease in the disparity of care between whites and minorities, suggesting equitability of treatment. (Journal of Healthcare for the Poor and Underserved, February 2012)

MedHOK Earns 2012 P4P Software Certification for 360Measures®
MedHOK announced it has achieved certification for its 360Measurement® software after testing successfully with Integrated Healthcare Association. The program also has received full NCQA HEDIS® certification. (MarketWatch, April 3, 2012)

UnitedHealthcare Report Recommends Adopting New Cancer Care Payment Model to Reward Physicians for Health Outcomes
UnitedHealthcare is exploring alternative payment strategies for compensating medical oncologists in the care of their patients. Two alternatives are described (see the Health Affairs article for more information on the program at http://content.healthaffairs.org/content/31/4/780.abstract); one a clinical pathway compliance program and the other a form of bundling. (MarketWatch, April 16, 2012)

Don Berwick, MD: Changing from Fee-For-Service to Bundled Payment for Medicare and Medicaid
This link contains a six minute video discussion with Don Berwick, MD in which he outlines his perspectives on payment reform. (CurrentMedicine.TV, April 5, 2012)

Methodological Considerations in Generating Provider Performance Scores for Use in Public Reporting - A Guide for Community Quality Collaboratives

This white paper from Rand and commissioned by AHRQ, is intended to assist community collaboratives such as Chartered Value Exchanges (CVEs) who must consider a wide range of options for performance reporting. (Published in: Agency for Health Research and Quality, (Contract No. HHSA290200810037C). AHRQ Publication No. 11-0093, U.S. Department of Health and Human Services, September 2011, 107 p)

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Getting to Cost of Care in California's P4P Program

Dolores Yanagihara, MPH
P4P Program Director, Integrated Healthcare Association, Oakland, CA