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Guide to Physician Performance-Based Reimbursement: Payoffs from Incentives, Data Sharing and Clinical Integration
Healthcare Intelligence Network, May 2011, Pages: 60
In tandem with adoption of post-reform care delivery models like the patient-centered medical home (PCMH) and accountable care organization (ACO), healthcare organizations are constructing payment and compensation models that reward physicians for improving population health, the patient experience and per capita cost — approaches that may lure more medical residents back to primary care.
The Guide to Physician Performance-Based Reimbursement: Payoffs from Incentives, Data Sharing and Clinical Integration explores newly minted reimbursement formulas at two health plans and two independent practice associations (IPAs), providing payor and provider perspectives on the formula development process; clinical, quality and efficiency measures in use; physician incentive payments and program outcomes.
This 60-page special report also examines the collection and sharing of physician performance data by these four organizations and the impact of data sharing on physician engagement, health outcomes, utilization and cost. Additionally, the Q&A section answers more than 25 questions on the programs presented in this resource.
The Guide to Physician Performance-Based Reimbursement: Payoffs from Incentives, Data Sharing and Clinical Integration documents the following physician performance-based payment programs:
After 14 years of administering pay for performance (PFP) programs for its 700 providers and specialists, HealthPartners has figured out what motivates physicians. Babette Apland, senior vice president of health and care management for HealthPartners, describes the payor's strategy for supporting transformation of care delivery, including its strategic framework, payment and compensation models, and population health data models. Apland describes the health plan's alignment of physician incentives and shared savings with pay-for-performance programs and a total cost of care initiative.
Mark Shields, MD, MBA, senior medical director for Advocate Physician Partners (APP) and vice president of medical management for Advocate Health Care, details the clinical integration (CI) program APP developed for its 3,000 physicians - from the structure of the CI group to funding, incentives, mechanisms and technology that support CI. Dr. Shields shares the key strategies of this IPA to improve physician performance and why a successful CI program can provide the framework for an accountable care organization.
Capital District Physicians' Health Plan Inc., (CDPHP), a network model health plan, launched a two-phase medical home pilot in 2008 to reform both the practice of primary care in its network and the payment to these physicians. Participating practices receive an incentive for practice transformation and are eligible for additional reimbursement for meeting quality and efficiency targets. Bruce Nash, MD, MBA, senior VP of medical affairs and CMO for CDPHP, describes how CDPHP met the challenge of developing a novel risk adjustment methodology that would drive a global payment combined with a significant bonus structure to attract physician participation and encourage future growth by medical students to enter primary care.
Taconic IPA, through a community transformation program, is leveraging performance reporting data to engage 237 physicians in its medical home pilot in quality improvement while increasing reimbursement rates for its physicians. Paul Kaye, MD, medical director at Taconic IPA and Susan Stuard, executive director, THINC, provide details from this multi-payor collaborative, describing how the sharing of data across its organization is improving physician performance and value-based reimbursement levels and other details from this multi-stakeholder initiative.
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