Incentives Institute October 20th 2008 BTE’s Lessons Incentives Institute October 20th 2008 François de Brantes, CEO Bridges To Excellence

Uncertainty and the Welfare Economics of Medical Care “Since the patients do not, in their belief, know as much as the physician, they cannot completely enforce standards of care. In part, they replace direct observation by generalized belief in the ability of the physician. To put it another way, the social obligation for best practice is part of the commodity the physician sells, even though it is a part that is not subject to thorough inspection by the buyer.” Kenneth J. Arrow, 1963

BTE’s goal has been to solve one of the many information asymmetries Recognized physicians have been reviewed by independent third party organizations Recognized physicians have to demonstrate that they are actually delivering good results Recognized physicians become highlighted in provider directories and other consumer reports to help consumers identify who’s adhering to standards But…you can’t get physicians to become recognized without incentives, because the fee-for-service system militates against taking on complex patients

Lessons Learned (in addition to It Works) Measure what matters – processes and outcomes that are tightly linked to patient risk reduction 1, 2 (e.g. BP control) – and aim for excellence (www.theD5.org) Collaborate for a common good (plans acting individually rarely succeed 3, 4) to create a critical mass of incentives (practice transformation is expensive) that pay off 5 Eddy et al, “The Potential Effects Of HEDIS Performance Measures On The Quality Of Care”, Health Affairs 09/2008 de Brantes et al, “The Value of Measures in Ambulatory Care”, AJMC 06/2008 Pearson et al, “Impact of P4P on Health Care Quality in MA”, Health Affairs 07/2008 Rosenthal et al, “Climbing up the P4P Learning Curve”, Health Affairs 11/2007 Rosenthal et al, “BTE: Recognizing High Quality Care”, AJMC 09/2008

The juice has to be worth the squeeze Likelihood of Physicians participating in BTE’s Diabetes Care Link Likelihood of Physicians participating in BTE’s Physician Office Link

Plans can only optimize the impact of their incentives by collaborating The more “covered lives” there are in a medical trading area the greater the likelihood physicians will participate in the incentive program and all will benefit.