Reflected in the "P4P Leadership Surveys," conducted by Managed Care Information Center, is the concern with the growing numbers of quality measures that are being included in programs making management of a program confusing at best.

The issue was raised by Hindy Shaman, director of the PricewaterhouseCoopers (PwC) Health Research Institute. "It’s a complicated undertaking – measuring quality – and part of the reason why it’s complicated and difficult is because we’ve got so many different dimensions of quality within health care, and everybody out there agrees," she told participants in an audio conference, "Keeping Score: A Comparison of Pay-for-Performance Programs Among Commercial Insurers," sponsored by Managed Care Information Center.

We’re in a situation right now where everybody wants quality and "the metrics are multiplying," Shaman said.

There are literally hundreds of different measures of quality and a lot of effort right now is being spent on trying to reconcile those different measures, she said. Federal agencies have measures, private agencies, and quasi-governmental associations have their measures.

Shaman noted that all of the stakeholder organizations and entities are meeting with each other, and "they are representing each other on each other’s board and spending lots of time in meetings to try to reconcile this huge mound of quality measures and try to reach some more consistency in what we’re asking providers to report."

"But we’re not quite there yet; we’re still dealing with situations where providers have a different score card for every payer that they contract with, every accrediting body that they need to report to and every governmental agency that they need to report to," Shaman said.

It’s no wonder physicians, especially, are frustrated with trying to keep up with the demands of the P4P programs.

"Even if the same types of things are being measured, the definitions may be different," Shaman said.

There are a lot of complaints, a lot of sensitivity on the part of providers to the burden that this creates for them administratively, she added.

Shaman said she and her PwC colleagues heard a lot about this issue in interviewing industry leaders. She said they then wondered how much variation was out there among and between P4P programs.

So, PwC surveyed 10 different large commercial payers about their P4P programs and reviewed their score cards.

"What we found in the research is that there was tremendous variation in measures. We found that on the commercial side, unlike Medicare in the public sector, physician pay-for-performance programs are more evolved than the hospital programs."

The PwC team looked at the actual score cards that are being used by the different plans and found more than 60 indicators of physician performance and "not one indicator was used by all 10 plans among those 60."

"No two of the plans paid providers for their performance in the same way," said Shaman.

Finally, and likely most disturbing to physicians, was the finding that all of the plans administered their programs in very, very different ways, according to PwC’s research.

Editor’s Note: A CD-ROM recording of the speaker presentations and all conference materials for "Keeping Score: A Comparison of Pay-For-Performance Programs Among Commercial Insurers" is now available to order online or by calling toll-free (800) 516-4343.

For more information visit www.healthresourcesonline.com/edu/p4p38.htm

Address: Health Resources Publishing, Managed Care Information Center, 1913 Atlantic. Ave., Suite 200, Manasquan, NJ 08736; (732) 292-1100, www.healthresourcesonline.com.

Standardize This: Health Plans’ Wide-Ranging Physician Performance Metrics For P4P Incentives
	1	2	3	4	5	6	7	8	9
Automated rating of adherence to evidence-based practice							X		X
Appropriate treatment for upper respiratory infection	X					X
Asthma – appropriate use of medications	X				X	X	X
Asthma care (several metrics)		X		X	X
Breast cancer screening	X	X			X	X	X		X
Cervical cancer screening	X	X		X		X	X
Colorectal cancer screening		X					X
Childhood immunizations (several metrics)	X	X			X	X
Well-child visits: 1st, 15 months, 3-6 years		X
Pediatric acute otitis media 1st line antibiotics use				X	X
Appropriate antibiotics use: various conditions					X
Adolescent well care visits, immunizations		X
Chlamydia screening	X			X
Atrial fibrillation management (several metrics)									X
Coronary artery disease management (several metrics)									X
Diabetes management (several metrics)	X	X		X	X	X	X		X
Hypertension management (several metrics)				X	X				X
Congestive heart failure management (several metrics)									X
Cholesterol screening		X			X	X
Cholesterol management: LDL control < 130						X
Statin use in members with ischemic heart disease							X
Cardiology discharge care with acute myocardial infarction				X			X
Cardiology rate control with chronic atrial fibrillation				X
Orthopedics total hip arthroplasty				X
Osteoprorosis management after fracture		X
Appropriate mental health management: attention deficient and hyperactivity disorder follow-up care					X
Assisting smokers to quit				X

Note: Plan shaded are Blues plans
Source: Health Research Institute, PricewaterhouseCoopers

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