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Rewarding Provider Performance: Aligning Incentives in Medicare

Explore how private payers can align incentives and reward providers effectively in Medicare, following the 2006 IOM report recommendations. Learn about key messages, coordination efforts, and guidelines for implementing performance-based payments.

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Rewarding Provider Performance: Aligning Incentives in Medicare

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  1. Rewarding Provider Performance: Aligning Incentives in Medicare Implications for Private Payers Robert Galvin October 16, 2006

  2. Big Picture • A Significant Turning Point in 40 Year Old Medicare Program • Good Example of Power of Public-Private Sector Coordination • We’re at the “End of the Beginning”. . . . A Lot of Work Left to Do

  3. IOM Report: There’s A Lot to Like • Unequivocal Recommendation to Medicare to Move for P4P • Strong Transparency Message • Strong Endorsement of Role of Health I.T. • Insistence on Efficiency and Patient-Centeredness in Addition to Effectiveness

  4. But It’s Not Everything We Hoped For • Evolutionary Change in Face of Health Care Crisis • Physician P4P: 3-Year Lag and No Clear Mandate • Pay for Reporting: In Most Other Sectors A Cost of Doing Business • No Clear Break From Fee-for-Service Model

  5. Three Key Messages for Private Sector Stay the Course . . . . . . . . . . . . Combined Public/Private Payment Critical Expand What’s Rewarded. . . .Efficiency, Care Coordination, Patient-Centeredness Coordinate Efforts . . . . . . . . . . .A Focused Message to Providers Will Accelerate Change

  6. High Level P4P Guidelines • Reward Improvement and Achievement • Use Measures That Have Been Through Consensus Process • Integrate Efficiency and Patient-Centeredness With Effectiveness Measures • Coordinate With Other Payers to Create Meaningful Rewards • Support the Development of an Evidence Base for P4P

  7. Thoughts on Next Steps for Employers • Use Contracts With Health Plans to Require: • Increasing Provider Payments Based on Performance • Use of Consensus-Driven Performance Measures (Rather Than Plan-Specific) • Public Release of Provider-Level Measures That Are Understandable to Consumers and Patients • Participation in the P4P Learning System • Reward Health Plans on Their Performance of These Specifications

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