Pay-for-Performance Programs to Improve Care
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Hudson Health Plan
Hudson Valley Area, New York
Diabetes
Medicaid-focused, Not-for-profit Managed Care Plan
Underserved minorities
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PROJECT
Health plan reaches out to enrollees and provides bonus payments to participating primary care providers for high-quality, patient-centered care.
Hudson sends members with diabetes a letter reminding them of the importance of an annual flu shot and enumerating
the other key components of their diabetes care. Sometimes the letters are customized to indicate the particular services needed by the patient. A gift card is offered to members whocomplete a visit with their primary care physician.
Practices can earn up to $300 per patient annually for complying with care standards. There are several individual screenings (e.g., blood pressure, HbA1c, LDL cholesterol) and immunizations (e.g., pneumococcal and influenza) which have payments attached to them. Reaching certain health outcome levels, as well as achieving relative improvements are
also incentivized. Provider payments and performance reports are delivered by Provider Relations representatives during an annual meeting where overall outcomes and opportunities for improvement are discussed.
RATIONALE
Pay-for-performance programs can improve outcomes for racial and ethnic minority patients, provided that they are designed to reward patient-centered care rather than population-wide results. Programs relying exclusively on population-wide outcome measures may encourage providers to avoid less adherent or sicker patients, exacerbating disparities or leaving them unchanged. The incentive amount is based on an estimate of provider effort needed, available resources, and prior
studies investigating the magnitude of incentive needed to engage provider interest.
By encouraging the regular monitoring and testing of diabetic patients, this pay-for-performance program hopes to improve overall health and quality of care. Medium and long-term savings in emergency care and inpatient costs may be realized, while near-term costs of care and medications may increase. It is possible that any long-term benefits will accrue once patients are no longer members of the plan.
EVALUATION PLAN
Funded by Finding Answers in 2008.
A pre-post analysis of diabetes cost and quality measures is being conducted to compare changes over time in process measures of diabetes quality for Hudson Health Plan to those reported for competing Medicaid health plans in New York State. The primary measures include HbA1c testing, LDL cholesterol testing and retinal exam. Individual screening rates and measures of service utilization are also being captured.
Primary care providers are being surveyed to determine their satisfaction with the program and how it was designed. The evaluation is also quantifying barriers to adoption of the program, and is evaluating the impact of a pay-for-performance program on utilization and total health plan spending for racial and ethnic minority enrollees with diabetes.
Principal Investigators:
- Janet Sullivan, MD (Chief Medical Officer, Hudson Health Plan)
- Meredith Rosenthal, PhD (Associate Professor, Harvard School of Public Health)
For More Information
Please Contact:
Janet "Jessie" Sullivan
jsullivan@hudsonhealthplan.org
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