The Business Case for P4P

1. The Business Case for P4P Douglas Allen MD., MMM. Chief Medical Officer Greater Newport Physicians IPA

2. What P4P Incentivises

3. Changes Directly Inventivised • Information systems to house clinical data • Disease Registry Creation • Clinical Quality Reports and Physician reminders (retrospective) • Point of Care Physician Reminders • Improved Access, Physician Communication and Specialty Care

4. Changes Indirectly Inventivised • Alternative uses of a Data Warehouse: Understanding Cost Trends • Using Data to Reach out to Members. Education and/or Marketing • EMR Development – Most Effective Strategy to Decrease Errors and Improve Efficiency/Effectiveness

5. Changes Indirectly Inventivised • Innovative Patient Engagement Strategies, to Further Improve Disease Control. • Innovative Scheduling Strategies. Possibly Doing Away with Scheduling Altogether. • Innovative Patient Communication Strategies. Online Consults, Email etc.

6. The Ideal State • Patient Centered Health Care. Patient Efficiently Interacts with all Members of the Health Care Team. Contextually Sensitive Educational Tools, Sent to the Patient Through Medium of Their Choosing. • Information Available at the Physician’s Fingertips, Including Insurance Guidelines, Guidelines for DM, Preventive Care and New Technologies. • Full Relational Database at Group Level, to used for both QI and Cost Control.

7. Ideal State (Cont.) • Point of care support for Physicians, Including Drug-drug Interactions, Medication Compliance, Labs etc.. • Physician Offices have Re-designed Work Flow to Flex to Individual patient Needs, Including use of Educational Aids, Planned Visit Tools, Group Visits etc. • Health Care Providers have Access to Health Related Patient Activity Regardless of Location Within the Community.

8. Progress Toward the Ideal • Relay Health, Individual Medical Group (e.g. Bristol Park) and other Strategies to Improve Patient Communication. • Numerous Vendor Strategies to Improve Physician Point of Care Support. Quest, Access Express, Physicians Web Link, Physician Associates etc. • Numerous Groups Building Clinical Data Warehouses or Relying on Vendors to Jumpstart Their Efforts. • BCCP Experiments, Demonstrating Applicability and Effectiveness of Office Re-design in the California Market Place.

9. Progress (cont.) • RHIO Concept put forth by David Brailer. Would Allow All Health Care Providers to Know about Health Related Activity for Every Patient Regardless of Location. • Wave of Advanced Access Pilots with and without Health Plan Support • Groups using their own Data Warehouses for Utilization Management, but Lack Benchmarking • Clinical Data Repository by CAPG. A Benchmarking Solution.

10. Reminder of last year’s Pay-out by health plan Plan 1 $0.25 Plan 2 $0.78 Plan 3 $0.94 Plan 4 $1.30 Plan 5 $1.38 Plan 6 $1.89

11. 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

12. GNP I.S. STRATEGY • Challenge : to Weave Together Many Applications and Solutions into a Single, Coherent, Overarching Strategy

22. Future Strategies • Online EMR • Connectivity with a RHIO • Advanced Access