Public Recognition Incentives for Quality Improvement

1. Public Recognition Incentives for Quality Improvement Tony Linares, MD Medical Director, Quality Improvement

2. Public Recognition Incentives Overview • Framework for Doctor’s Office Quality Project (DOQ). • What does the evidence show? • Public reporting versus recognition. • What are QIOs currently doing?

3. Framework for DOQ Incentives • Physician office quality measures for 8th SOW. • Public reporting literature research. • Why is public recognition different? • Evidence that public recognition works for medical opinion leaders. • Survey findings of 15 QIOs who have used public recognition.

4. Model includes performance measures in Clinical Quality Patient Experience of Care Systems of care Sources: Administrative and office-generated data Doctor’s Office Quality Pilot Project • Develop a model for measurement and improvement of chronic disease and preventive service delivery in individual physician/medical offices.

5. Doctor’s Office Quality Pilot Project Partnerships • Develop and maintain partnerships with appropriate stakeholders including DHS, CMA, PBGH, trade organizations, health plans, and medical groups. Physician Champion Network • Promote quality improvement in physician offices. • Serve as team leaders, clinical experts, and Collaborative faculty in CMRI initiatives. • Opinion leaders facilitate the diffusion of knowledge and best practices.

6. Public Recognition • Growing number of articles on report cards, performance data, and changing physicians behavior. • Limited evidence-based articles on public recognition.

7. Changing Physician Behavior: Clinical Practice is Difficult to Alter • Traditional medical education is limited. • Reminders are more effective. • Systems support at the time of decision making is good. • Academic detailing is very effective, but resource intensive. • Innovation diffusion through local opinion leaders or “champions” is effective. • Multiple implementation tools are more effective.

8. Opinion Leaders to Improve Quality of Care “After hearing an explanation of the opinion leaders’ role, the identified opinion leaders began to take on a new commitment to improve practices in their community. They were “proud” of their designation as an opinion leader among their peers.” Collins, B. A., Hawks, J. W., Davis, R. From Theory to Practice: Identifying Authentic Opinion Leaders to Improve Care. Managed Care, July 2000: 56-62.

9. Clinical Champions Are Instrumental in Leading Change • Having a good understanding of the social and communications networks developed by their physicians helps health care organizations spread “better practices” to these practitioners. • Innovation Stewardship (Comsort’s model) is used to identify influential leaders in a physician community. Collins, B. A., Hawks, J. W., Davis, R. From Theory to Practice: Identifying Authentic Opinion Leaders to Improve Care. Managed Care, July 2000: 56-62.

10. Physician Profiles: status report • About 25% of primary care physicians find profiles useful. • About 16% of purchasers report using clinical outcome data to make health plan choice. • Physicians are interested in but skeptical about physician profiles: • Intent • Accuracy • Physician attribution • Relevance

11. Report Cards: status report • Should be redesigned to provide useful QI information – actionable items on structure/processes of care. • Providers desire information on processes of care, not just outcomes. • Provides timely and practical information about the process of care. • Purchasers/consumers value process/consumer satisfaction more than clinical outcome measures.

12. Pay for Performance (IHA)* in CA. Key Features • A balanced scorecard that incorporates patient satisfaction, clinical measures, and IT system change. • Public reporting of results. • Reward quality improvement by physician groups with financial incentives. *Integrated Healthcare Association. Pay for Performance. A Business Case for Rewarding Physician Group Excellence, 2002. http://www.iha.org/payfpov1.htm

13. Recognition & Consumer Choice: lessons from performance data • Want more information about health care provider performance. • Performance data have a limited impact on consumer decision making. • Difficulty in understanding the information, lack of trust in the data and choice. • Continue to rely on family and friends.

14. Excellence in Quality Kansas QIO Award Program

15. Learning from each other • DOQ Project builds upon proven, successful public recognition programs. • CMRI distributed assessment to 15 QIOs. • Achieved an 80% response. • QIO public recognition for participation.

16. Key Findings • Hospitals are primary target population. • 1-3 year programs are most common. • Majority will continue efforts in 7SOW. • Majority are co-sponsored by another organization.

17. Key Findings • Award for participation in QI projects is top criteria. • Certificates of achievement, press releases, newsletters, and Web site announcements are popular media. • Many will maintain current funding. • Majority have not implemented evaluation plans.

18. Barriers • Providers not recognized may have concerns about results. • The bar was too high and should be redesigned for 7SOW. • Program should accommodate large and small facilities. • Agreement and communication of award criteria is essential. • Buy-in from local medical societies is key. • Putting aside bias, “playing favorites.”

19. Lessons Learned • Make sure criteria is consistent, clear, and published. • Promote the program and criteria in advance. • Encourage leadership involvement and recognize all participants. • Develop separate award for CEO of award-winning facility.

20. Next Steps in Public Recognition • Continue collaboration with key partners. • Strive for consensus on recognition criteria. • Seek meaningful recognition awards. • Recognize physician opinion leaders and clinical champions. • Integrate public recognition in change packages. • Develop an evaluation plan.

21. JAMA – January, 2003 “Rewarding Physician Organizations (POs) for improving quality of care is important. Giving POs public recognition and better contracts for scoring well on quality measures is associated with the use of 2.0 additional care management processes.” Casalino, L., et al. External Incentives, Information Technology, and Organized Processes to Improve Health Care Quality for Patients with Chronic Diseases. Journal of the American Medical Association, Jan. 2003, Vol. 289, No. 4:434-441.

22. Information Antonio Linares, MD, 415-677-2121 or capro.alinares@sdps.org Julia Heinzerling, MPH, 415-677-2060 or capro.jheinzerling@sdps.org