Overview of P4P Initiatives and HIT Incentives Kelly Cronin Senior Advisor to the Administrator Centers for Medicare and Medicaid Services August 2005

Why is P4P necessary? Physicians and other health care providers want to deliver high quality care Physicians and other health care providers want to deliver high quality care Current FFS system rewards volume of services – encourages unnecessary and duplicative services Current FFS system rewards volume of services – encourages unnecessary and duplicative services Payers need to improve the business case to realize system level change Payers need to improve the business case to realize system level change Payment tied to performance means: Payment tied to performance means: HIT infrastructure is necessary to measure and report performanceHIT infrastructure is necessary to measure and report performance Providers will be more likely to make investments in HIT as products mature to reduce burden of data collection and reportingProviders will be more likely to make investments in HIT as products mature to reduce burden of data collection and reporting

Cross cutting themes for P4P CMS-wideCMS-wide Medicare Part A and B, Medicaid, SCHIP Medicare Part A and B, Medicaid, SCHIP HITHIT Patient centerednessPatient centeredness Enable evidence based medicineEnable evidence based medicine Reduce health disparitiesReduce health disparities

Foundation of P4P: Valid Quality Measures Hospital Quality Alliance – started with 10 measures, now 20 are in Hospital Compare ( Hospital Quality Alliance – started with 10 measures, now 20 are in Hospital Compare ( Nursing Home Quality Initiative – 15 quality measures in Minimum Data Set and Nursing Home Compare Nursing Home Quality Initiative – 15 quality measures in Minimum Data Set and Nursing Home Compare Ambulatory Care Quality Alliance – 26 primary care quality measures Ambulatory Care Quality Alliance – 26 primary care quality measures

What can we implement now? Pay for reporting Pay for reporting Hospital payment update tied to reporting of quality measuresHospital payment update tied to reporting of quality measures Now being proposed for ambulatory care as first step towards p4pNow being proposed for ambulatory care as first step towards p4p Claims based approach early on is feasible given existing infrastructureClaims based approach early on is feasible given existing infrastructure

How do we get to P4P? Need to know how to capture and aggregate data Need to know how to capture and aggregate data Expand the measure set Expand the measure set Specialty measuresSpecialty measures Efficiency measuresEfficiency measures Pilot p4p leveraging existing efforts to establish rules of the road Pilot p4p leveraging existing efforts to establish rules of the road Regions where claims data is already aggregatedRegions where claims data is already aggregated Regional health information exchangeRegional health information exchange Areas with high EHR adoption ratesAreas with high EHR adoption rates Learn how to combine data from various sources (claims, pharmacy, labs)Learn how to combine data from various sources (claims, pharmacy, labs) Test existing and new ways to get data from physician offices (certified EHRs, secure network, web-based data collection tools)Test existing and new ways to get data from physician offices (certified EHRs, secure network, web-based data collection tools)

Interoperable HIT: a Key Element of P4P Programs Can’t fully implement p4p without HIT Can’t fully implement p4p without HIT Need incentives for EHR adoption Need incentives for EHR adoption Pending changes to Stark and Anti-kickback Pending changes to Stark and Anti-kickback Pay for performance will require investment interoperable EHRs Pay for performance will require investment interoperable EHRs Enable reporting of data for quality measuresEnable reporting of data for quality measures Certification will ensure needed functionality and interoperabilityCertification will ensure needed functionality and interoperability Leverage health information exchange programs to capture and aggregate data for measuresLeverage health information exchange programs to capture and aggregate data for measures

Interoperable HIT: a Key Element of P4P Programs Ensure successful EHR implementation in physician officesEnsure successful EHR implementation in physician offices Doctors Office Quality –IT (DOQ-IT)Doctors Office Quality –IT (DOQ-IT) QIOs assist primary care physicians in selection of EHRs QIOs assist primary care physicians in selection of EHRs SOW calls for support for IT implementation in primary care practices in each state SOW calls for support for IT implementation in primary care practices in each state Support re-design of care processes and evidence based decision making while reducing implementation failure Support re-design of care processes and evidence based decision making while reducing implementation failure

Near term opportunities to define intersection of P4P and HIT AQA pilots over next 6 months leveraging existing effortsAQA pilots over next 6 months leveraging existing efforts Bridges to ExcellenceBridges to Excellence MMA 649 demonstration program implemented in 4 statesMMA 649 demonstration program implemented in 4 states Regional health information exchange programs starting in areas with P4P programsRegional health information exchange programs starting in areas with P4P programs