The US Spends Twice As Much on Health Care As Any Other Industrialized Nation (15-18% of GNP or 12+ Cents of Each Dollar) – Pay for Performance (P4P) Key Information and Strategies

Research and Markets (http://www.researchandmarkets.com/reports/c32946) has announced the addition of Pay for Performance (P4P) Key information and strategies to drive the quality of care to their offering

The report ‘Pay for Performance (P4P) Key information and strategies to drive the quality of care’ focuses on the following:

History, concepts, pros, cons, quality issues, example programs now functioning successful, Medicare plans for P4P compensation, extensive references, resources, web links, benchmarks.

Cost and effectiveness of US healthcare

The US spends twice as much on health care as any other industrialized nation (15-18% of GNP or 12+ cents of each dollar) with a continued escalation of health care costs that far exceed inflation rates. These increased costs do not equate with improved health outcomes in the U.S. The U.S. population ranks 20th in life expectancy for men and 15th for women. To manage costs and improve care, a renewed focus on the medically necessary elements of care that makes a difference in outcome is needed. At times, this requires separating issues of ‘wants’ from ‘needs’ – e.g., one obstetrical ultrasound may be medically justified on the basis of preventive health care screening even in an apparently normal pregnancy without familial or other risk factors, but additional ultrasounds based on demands of the patient or her family are not justified.

Issues adversely affecting quality of care

— High variability or inconsistent treatment amongst or by professional care providers

— Lack of standards or information not readily available through resources such as specialty consultation

— Patients are not treated using current guidelines for care of a given condition – both undertreatment (including underuse of some drug classes) and inappropriate/excessive treatments are major drivers leading to adverse outcomes

— Patient noncompliance – may be economic (unable to afford the cost of care or prescriptions) or related to adverse effects of drugs, unacceptable dietary restrictions or other difficult-to-follow recommendations such as frequent medication doses and cultural issues.

Contents Include:-

Introduction/Disease Management/Guidelines

Pay for Performance

Bridges to Excellence

Commonwealth Fund Opinion Leaders Survey

Supporting P4P – example

Requirements for physician ‘buy-in’

Massachusetts Medical Society Guidelines for Measuring, Reporting, and Rewarding Physician Performance

BlueCross BlueShield of Minnesota P4P by condition audit form links

Computer order entry (CPOE)

Group visits

Quality improvement tool box, ambulatory care

Definitions, introduction

CQI Obstacle Busting/Bridge Building Teams

Medical Group Service Evaluation – patient questionnaire form

Brief patient satisfaction example survey question

Quality measures

Reminders

7 types of interventions

Preventive health care interventions for high risk populations

Improving provider compliance

HEDIS Measures

Clinical performance measures for CAD

Presurgical screening tests

Follow-up tracking

Abnormal pap smear follow-up

Mammogram follow-up tool

Unplanned readmissions and data collection tool

Case or care management

Controlling Costs while Improving Quality of Care for Patients with Multiple Medical Conditions

Clinical Performance Measures for Ambulatory Care – table (ACP)

Case Mix Adjustment

Ohio KePro physician office quality improvement tool kit – links

Sentinel event reports, root analysis format – P & P

Quality notes

Resources

Ethics Manual – link

Medicare pay for performance initiatives

Provider Profiles: Example indicators for tracking/trending

Provider Profiling or Report Cards – Medical Group Example

Health Plan QI/UM Clinical Indicators/Performance Goals

Hospital/SNF QA Screens

Crosby Quality Quotes

Staff quality certification resource

Survey sampling error estimates

References

Thoughts for the unwary

Web sites – links

For more information visit http://www.researchandmarkets.com/reports/c32946