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Home / News & IndustryManaged Care Insight and Analysis
Updated: November 10, 2009
Through The Looking Glass: What Health/Managed Care Executives See Ahead For P4P

Aligning incentives to determine what measures count, expanding scrutiny of the effectiveness of P4P, ensuring quality is the driver, no gains in terms of quality, standardization of measures and a continued increase in P4P programs, are among the expected actions and issues seen ahead for programs awarding incentives to physicians and hospitals for increasing quality and patient satisfaction, according to the results of our P4P Management Leadership Survey.

"Aligning incentives to define what counts as ‘results’ is the next crucial step," believes Paul Cook, assistant professor at the University of Colorado, Denver.

"For example, as more effective patient-to-treatment matching becomes available, we may no longer see incentives for prescribing preventive treatments for all patients, but only for those at greatest risk or those who are believed to be most likely to respond to the treatment," Cook said

Dee Brown, senior associate with Open Minds, suggested hospital readmission reductions in pay for readmissions within seven days. She also sees medical home shared cost savings.

"Though performance measurement will likely continue, P4P as an incentive will need more scrutiny as an effective way to change behaviors," said Dr. Joe Nichols, the medical director at ViPS.

A clinical analyst with a physician organization sees a focus on how to present programs on P4P and ensure quality is the driver vs. dollars.

The outlook ahead includes "expansion, more friction, poorer care, no gains in terms of quality, chaos, conflict, and marketing which distorts the nature and effect of the programs," offered an attorney for physicians.

Bigger aggregations, standardization of measures is necessary said a senior director of health measurement solutions with a consulting firm.

"More outcome measures" is predicted by a vice president of network development and provider relations with a managed care organization.

Vivien Tran, quality incentive programs manager with Coast Healthcare Management, sees "Physician frustration with P4P as they are being evaluated on more criteria and are being asked to do more."

There will be a "more direct connection to preventive health programs," observed Raul Recarey, director of health programs with Wells Fargo Insurance Services.

"As physician practices begin to embrace EMR, gathering data in ‘real-time’ from the electronic record" will be possible, according to a senior director, medical quality with an MCO. "The evolution of EMRs will incorporate the ability of identifying and tracking quality of care measures."

Payors will be increasingly evaluating current programs to determine their impact, believes the director of managed care with a physician organization.

There will also be a continued increase for P4P programs, said the president of Medical Reimbursement Data Management, a consulting firm.

P4P will need "ROI, moving money from specialists to primary care," predicts Edward Scanlan, a medical director with a managed care organization. "Risk adjusting all programs and a move in interest to the medical home" are also on the horizon.

There will be "continued creation of minimally effective programs," observed a vice president of payer contracting with a physician organization.


What type of organization do you work for?

Consulting organization – 35.3 percent

Managed care organization – 29.4 percent

Physician organization – 23.5 percent

Hospital/Medical center – 11.8 percent

Other healthcare provider – 11.8 percent

Source: Pay-for-Performance Leadership Survey, Copyright 2009, Managed Care Information Center


The Pay-for-Performance Leadership Survey was conducted online among subscribers to Pay-for-Performance Reporter, The Executive Report on Managed Care and the Managed Care Weekly Watch.

  This article was taken from:
The Executive Report on Managed Care

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