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Braving the New World of P4P ! Tiffany Berry, MD Medical Director of Quality & Patient Safety Scott & White Healthcare Assistant Professor Family Medicine.

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Presentation on theme: "Braving the New World of P4P ! Tiffany Berry, MD Medical Director of Quality & Patient Safety Scott & White Healthcare Assistant Professor Family Medicine."— Presentation transcript:

1 Braving the New World of P4P ! Tiffany Berry, MD Medical Director of Quality & Patient Safety Scott & White Healthcare Assistant Professor Family Medicine TAMHSC

2 Objectives… What is Pay for Performance? How will primary care be measured? What are the current plans for reimbursement change?

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4 Snapshot of P4P… Rewards Quality not Quantity Do Good = Do well More than ½ of private health plans use P4P in their provider contracts

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6 PPACA established the Center for Medicare and Medicaid Innovation. Gives broad authority for the HHS secretary to test innovative payment methods for medical homes that provide patient- centered coordinated care and for bundled hospital acute and post-acute care. Nearly all health care opinion leaders (97%) support reforming provider payment to promote quality and efficiency Stimulating Provider Payment Reform…

7 HHS secretary is tasked with developing a National Strategy to Improve Health Care Quality Requires public reporting of physician quality and patient experience measures through the "Physician Compare" Web site for Medicare beneficiaries. Promoting QI & Public Reporting

8 Inventories of programs across all types of payers document more than 100 pay-for- performance programs In a national survey, 52% of HMOs (covering 81% of enrollees) report using pay-for- performance Baker G, Carter B. The Evolution of Pay for Performance Models for Rewarding Providers. In: Introduction to Case Studies in Health Plan Pay-For- Performance. Washington, DC: Atlantic Information Services; Rosenthal MB, et al. Pay-for-Performance in Commercial HMOs. New England Journal of Medicine, in press. Who really does this?

9 So…this is a good thing? No measurable impact on cost thus far Unintended Outcomes: – Reward Process not outcomes – Encourage providers to « cherry pick » – Discourage treating the underserved


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