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American Public Health Association. Does NCQA Diabetes Recognition Impact Prevention Quality Indicator (PQI) Performance?. Joseph A. Stankaitis, MD, MPH Laura Weisbein, PhD Julian Allen , RN, MSN, MBA October 30, 2012. American Public Health Association. Presenter Disclosures.

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American public health association
American Public Health Association

Does NCQA Diabetes Recognition Impact

Prevention Quality Indicator (PQI) Performance?

Joseph A. Stankaitis, MD, MPH

Laura Weisbein, PhD

Julian Allen, RN, MSN, MBA

October 30, 2012


American public health association1
American Public Health Association

Presenter Disclosures

Joseph A. Stankaitis, MD, MPH

The following personal financial relationships with commercial interests relevant to this presentation existed during the past 12 months:

No relationships to disclose


American public health association2
American Public Health Association

Monroe Plan:

  • Healthcare Services Organization

  • Contracted Delivery System with Excellus BlueCross BlueShield to Provide Care in Finger Lakes and Southern Tier Regions for Enrollees in:

  • - Medicaid Managed Care

  • - Family Health Plus

  • - Child Health Plus


American public health association3
American Public Health Association

NCQA Diabetes Recognition Program (DRP):


American public health association4
American Public Health Association

  • Adult Prevention Quality Indicators (PQIs) Quantify Avoidable Events Through High-Quality Outpatient Care:

  • Diabetes Related:

  • Uncontrolled Diabetes Admission

  • Diabetes Long-Term Complication Admission

  • Diabetes Short-Term Complication Admission

  • Lower Extremity Amputation Among Patients with Diabetes

  • Other Conditions (Excluded Low Birth Weight):

  • Adult Asthma Admission

  • Angina Without Procedure Admission

  • Bacterial Pneumonia Admission

  • COPD Admission

  • CHF Admission

  • Dehydration Admission

  • Hypertension Admission

  • Perforated Appendix

  • UTI Admission


American public health association5
American Public Health Association

  • Study Design:

  • Monroe County (Rochester, NY)

  • Comparison Groups

  • - Physicians with NCQA DRP Recognition > 12 Months (n = 148)

  • - Physicians Without NCQA DRP > 12 Months (n = 413)

  • Compared Rates for 13 PQI Indicators

  • Time Period One Year 2011


American public health association

American Public Health Association

Findings:

  • NCQA DRP Recognized Physicians:

  • Overall PQI Rate 30.4% Lower

  • Diabetes PQI Rate 54.5% Lower

  • Non-Diabetes PQI Rate 20.3% Lower


American public health association

American Public Health Association

Pay for Performance ROI:

  • NCQA DRP Recognized Physicians:

  • Receive Diabetes Care Management Fee ($8.50/Diabetic Member/Month)

  • Total Diabetes Care Management Fee Payment to DRP Recognized Physicians:

  • $93,330 (915 Patients)

  • Savings from Avoided PQIs: $188,453

  • ROI: Savings from Avoided PQIs

  • Diabetes Care Management Fees

  • = 2.02


American public health association

American Public Health Association

Conclusions/Implications:

  • Physicians with NCQA DRP Recognition Appeared to Have

  • Lower Rates for Preventable Quality Indicators

  • Might be Due to Practice Improvement Activities Implemented to Achieve the Recognition

  • Could Mean that Only High-Performing Physicians Apply for NCQA DRP Recognition

  • We will be Examining Data from Previous Years to Further

  • Investigate This Point

  • There is a Potential ROI in Rewarding Physicians for Generating Cost Savings for Better care Delivery as Evidenced by Lower Rates of PQIs