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Braving the New World of P4P !

Braving the New World of P4P !. Tiffany Berry, MD Medical Director of Quality & Patient Safety Scott & White Healthcare Assistant Professor Family Medicine TAMHSC. Objectives…. What is Pay for Performance? How will primary care be measured?

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Braving the New World of P4P !

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  1. Braving the New World of P4P! Tiffany Berry, MD Medical Director of Quality & Patient Safety Scott & White Healthcare Assistant Professor Family Medicine TAMHSC

  2. Objectives… • What is Pay for Performance? • How will primary care be measured? • What are the current plans for reimbursement change?

  3. Snapshot of P4P… Rewards Quality not Quantity Do Good = Do well More than ½ of private health plans use P4P in their provider contracts

  4. Stimulating Provider Payment Reform… • PPACA established the Center for Medicare and Medicaid Innovation. • Gives broad authority for the HHS secretary to test innovative payment methods for medical homes that provide patient-centered coordinated care and for bundled hospital acute and post-acute care. • Nearly all health care opinion leaders (97%) support reforming provider payment to promote quality and efficiency

  5. Promoting QI & Public Reporting • HHS secretary is tasked with developing a National Strategy to Improve Health Care Quality • Requires public reporting of physician quality and patient experience measures through the "Physician Compare" Web site for Medicare beneficiaries.

  6. Who really does this? • Inventories of programs across all types of payers document more than 100 pay-for-performance programs • In a national survey, 52% of HMOs (covering 81% of enrollees) report using pay-for-performance Baker G, Carter B. The Evolution of Pay for Performance Models for Rewarding Providers. In: Introduction to Case Studies in Health Plan Pay-For-Performance. Washington, DC: Atlantic Information Services; 2004. 2. Rosenthal MB, et al. Pay-for-Performance in Commercial HMOs. New England Journal of Medicine, in press.

  7. So…this is a good thing? • No measurable impact on cost thus far • Unintended Outcomes: • Reward Process not outcomes • Encourage providers to « cherry pick » • Discourage treating the underserved

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