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