|
|
 |
December/2009 |
| Health Care Incentives Improvement Institute, Inc. |
Issue No. 4 |
|
Greetings!
The HCI3 team would like to thank you for your support in 2009. In this issue you will find brief updates about the BTE Programs and the PROMETHEUS Payment Model, as well as interesting things happening at pilot sites, including our work to date to improve/deliver high quality care. |
|
CEO Corner
Ready for change
As 2010 gets launched, it's pretty clear that this new year will be different than previous ones. The expansion of health insurance coverage to millions of uninsured and underinsured will change the way funds are being allocated in health care today. The current cost shifting that occurs and results in far higher prices paid by the private sector will no longer have an economic or social justification. Medicare will have many mandates to pilot with new and better forms of payment, and then to rapidly spread the pilots across the country with proof of concept. Funding for cost and quality measures should lift us out of the current excuses to not measure what should be measured. All this represents a huge opportunity for private sector health plans to experiment with and aggressively deploy value-based purchasing efforts, and employers across the country should push as hard as possible to demand higher value for the dollars they spend. We've been readying for this change for over two years, and now have the tools, resources and experience to help employers and health plans design and implement initiatives that will measurably improve the incentives in the delivery system and lead to higher value - both better quality and lower cost of care. Our flagship programs can be deployed "as is" rapidly, but we're also geared up to develop and implement custom solutions, as we have recently in a number of communities. The only reason left for costs of care to increase more rapidly than inflation is comfort with the status quo, because we all know what can and should be done, and we're ready to get it done with those that have the will to and desire for change. |
|
Programs Update:
Recognitins for (close to) all
We now have a dozen Recognition programs that are used to power up P4P initiatives, create comprehensive scorecards for physician practices, and even help plans in creating their "select" networks. As a result, health plans representing over 60 million US residents are now using the Recognitions. We also have 21 cost of care measures, our Prometheus Evidence-informed Case Rates (ECRs) that are being used by plans and employers across the country to calculate opportunities for increasing the value of their health care spend. And many plans will be reporting their rates of Potentially Avoidable Complications (PACs) that result from using our ECR Analytics. Consistent with our endorsement of the Consumer-Purchaser Disclosure Group's principles for incentive and transparency programs, the measures we're using in our Recognition programs are either already endorsed by NQF, NCQA, and/or the PCPI. And we've also submitted our definitions for PACs to the NQF for endorsement as comprehensive complications of care measures. What all this means for employers and health plans, is that our programs will help them move the dials in the right direction in the years to come. |
|
Health Plan Highlight:
A fast track to endorsement in NY State
For the past 18 months we've been working closely with the NY State Health Foundation and its Diabetes Policy Center to encourage all health plans in NY State to offer financial incentives to physicians that delver better care for patients with diabetes through an official endorsement. One way to achieve that endorsement is for plans to incorporate the BTE and NCQA Recognitions in their physician incentives formulae. And some of our partners in NY are either already endorsed by the NY State Health Foundation (CDPHP) or on a solid track to endorsement (Wellpoint, Aetna, Cigna), and we'll be continuing that work into 2010. |
|
Physician Performance Assessment Highlight:
EMR-based BTE Recognitions surge In just the past month we've had dozens of physicians receive BTE Recognitions by submitting their data to one of our Performance Assessment Organizations via their EMR system. These physicians include those using NextGen, GE and EPIC EMRs, as well as others who used applications such as CINA and MedicalEdge. Other physicians have used a direct submission portal set up by IPRO and others a direct submission portal set up by the Aligning Forces for Quality project in Cincinnati. The successful submission of data by physicians using different EMR systems has shown us how effective that modality can be in assessing physician quality, and has shown policymakers that it can be done...because we're doing it. |
|
PROMETHEUS Implementation:
Five going on ten
With five pilot sites already in various stages of implementation, we're looking forward to launching another five in sites across the country. The current diversity of the pilots are yielding important findings that we will continue to share in our quarterly updates. Our main lessons from 2009 are simple enough: (1) there is no single formula for implementing an episode of care payment model, (2) behaviors can change rapidly, and (3) the Prometheus payment model is actually quite simple from the providers' perspective. And importantly, the model is fully operational and scalable. | |
|
|
| Register by December 31, 2009 to receive the $995 early bird registration rate |
The Fifth National Pay for Performance Summit is scheduled for March 8-10, 2010 at the Hyatt Regency hotel in San Francisco, California. The National Pay for Performance Summit is the leading national forum on pay for performance, transparency and value driven healthcare. The summit is sponsored by the Integrated Healthcare Association, National Quality Forum, the National Committee for Quality Assurance, Agency for Healthcare Research and Quality, Bridges to Excellence, and the Leapfrog Group.
|
|
|
About Us
© 2009 Health Care Incentives Improvement Institute, Inc. All rights reserved. HCI3 does not endorse any particular product or service or any physician or physician group. HCI3 relies on third-party performance assessment organizations such as the NCQA and Quality Improvement Organizations to measure a physician or physician's group performance and ability to demonstrate that they meet certain measures of quality care. |
|
|
|
|
|
