Topic last updated Jan. 2006
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Addressing Issues
Aligning
Payment Policies with Care: Examples and Case Study Concerning Payment
Structure
Examples
The National Business Group on Health Bridges to Excellence Plan
In this example, employers and health plans partner to provide incentives to physicians to deliver care that is associated with good outcomes in their patients. A description of the these Pay for Performance activities are included in a briefing paper that provides:
- Discussion of two initiatives
- Results and measures
- Success factors
- Steps for employers when considering initiatives.
Click here for the Issue Brief July/August 2004 “Pay for Performance: Emerging Solution for Value-Based Purchasing” provided with permission from the National Business Group on Health www.businessgrouphealth.org.
How
an Incentive System Can Work: California's Pay for Performance
Plan.
In January
2002, California's six largest health plans agreed to support a
single physician performance scorecard and a new Pay for Performance
initiative expected to deliver $100 million in incentives each year
to doctors who contract with HMO plans. The goal is to create more
motivation for physicians to perform a variety of quality and preventive
care actions for which they have not been previously rewarded.
The
six health plans - Aetna, Blue Cross of California, Blue Shield
of California. CIGNA, Health Net, and PacifiCare - serve more than
8 million Californians. The plans have set aside 5 - 10 percent
their funds to reward doctors in the program. All six expect to
have a Pay for Performance process in place by January 2003.
Executives
from the health plans, which all belong to the non-profit Integrated
Healthcare Association, estimated that the incentives should reach
35,000 physicians, or 70 percent of the doctors actively practicing
in the state. The incentives will apply only to capitated enrollees
in HMO plans - not enrollees in PPO programs, the state Medicaid
program or individual Medicare Plus choice plans. The incentives
would be applied in addition to the capitated payments the insurers
already award to doctors. Each health plan can design its own incentive
program based on the common scorecard and also request contracting
doctors to provide more data for an individual health plan scorecard.
The groups that rank in the bottom 25 percent of the universal scorecard
probably would not receive any incentive payments.
The
Pay for Performance system will be based on a balance of prevention,
chronic care management, and patient satisfaction measures.
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Fifty percent of the score will be derived from clinical measures
such as effective screenings for breast and cervical cancers,
management of chronic care conditions (asthma, diabetes and heart
disease) and administration of childhood immunizations. Programs
in smoking cessation and antibiotic markers have yet to be defined,
but will be added to the score.
- Forty
percent of the score will come from patient satisfaction measures.
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Ten percent will be determined by information technology implementation.
An
independent entity will validate the data presented by health plans
and publish the results, most likely on a public Web site.
Please
note: Some
links on this page take you outside the Better Diabetes Care website. The NDEP
does not endorse or otherwise guarantee the accuracy of links that take you out
of this website.
Online
Report Card.
www.opa.ca.gov/report_card
As part of the effort in California to help consumers make informed
health care decisions, an online report card has been compiled.
The report card currently compares a list of HMOS, rating them as
poor, fair, good, or excellent in five different areas of quality
and service - "Staying Healthy," "Getting Better",
"Living With Illness," "Doctor Communication and
Services," and "Plan Service." The report card will
soon include information on 81 medical groups, which provide health
care services to more than 10 million Californians enrolled in point
of service plans or commercial and Medicare HMOs. Information for
the report card will come from the 2002 Consumer Assessment Survey,
which measures consumers' access to primary and specialty
care, patient/physician communication, overall care and preventive
care counseling.
The
information will be available online and in printed form, and will
be offered in Spanish and Chinese, as well as English.
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