1. Young 2004 Evaluation of the Rewarding Results Program Gary Young, J.D., Ph.D. Boston University School of Public Health and Department of Veterans Affairs Boston, MA

2. Young 2004 Rewarding Results: Seven Demonstration Projects DEMONSTRATION PROJECTUNIT OF ACCOUNTABILITY GEOGRAPHIC REGION Blue Cross Blue Shield of MichiganHospitalsMI Blue Cross of CaliforniaIndividual physiciansSan Francisco Bay area Bridges to ExcellenceIndividual physicians & Group practices Cincinnati, OH Louisville, KY Boston, MA Albany, NY ExcellusIndividual physiciansRochester, NY Pay for Performance – Integrated Healthcare Association Group practicesCA Local Initiative Rewarding Results – Center for Health Care Strategies Individual physicians & Group practices CA Massachusetts Health Quality Partners Group practicesMA

3. Young 2004 Quality Targets  Scoring 75% threshold 67%, 75% thresholds 83% threshold % improvement  Selected quality targets HbA1c screening Diabetic eye exam Mammography Well-child visits

4. Young 2004 Withhold (5% - 20% of claims) Block bonus potential to group (e.g. $60,000/40 primary care physicians; $1.2 million/280 primary care physicians) PMPM bonus potential for total panel (e.g. $1.50 per member per month; $3.00 per member per month) Hybrid: withhold and bonus Enhanced fee schedule in subsequent year Financial Incentive Arrangements

5. Young 2004 Practice Behavior Quality Targets Feedback Conceptual Framework: Financial Incentives and Quality Provider Perceptions Awareness Financial salience Scientific/clinical credibility Scope of control Fairness Unintended consequences

6. Young 2004

8. Telephone Interviews with Physician Practice Leaders Importance of dollars Complexity of distribution formulas Clinical relevance of quality targets Validity of data Role of individual physicians (physician-centered vs. system- oriented)

9. Young 2004 Conclusions Physician attitudes may differ from public commentary Providers appear confused about administration of programs Providers are comfortable with clinical relevance of quality targets but are not impressed with the associated dollars