1. Leadership and Advocacy in Pay-for-Performance: Assessing Your Needs (Including Strategies to Meet Them!) University of Minnesota DFMCH David J. Satin – Faculty dsatin@umphysicians.umn.edu Carrie Link MD – G3 Sandeep Kalola – G2 Justin Miles – M3

2. Following this session, you will be able to: 1.Identify your academic programs’ individual needs with regard to P4P programs. 2.Provide strong arguments, including data when available, supporting specific quality measures and design elements of P4P programs that favor these needs. 3.Cite resources available to further support successful negotiations with P4P program administrators and corporate or government leadership.

3. Schedule 1.Welcome, introductions, and layout/purpose of seminar (Dr. Satin - 5 minutes) 2.P4P background, definitions, and common language (Dr. Satin – 5 minutes) 3.Participants individually fill out needs assessment survey in preparation for town hall discussion and to compare with Minnesota survey data to be presented (Participants – 5 minutes)

4. Schedule 4.Presentation of Minnesota P4P needs assessment survey data and analysis (Dr.’s Link and Kalola – 15 minutes) 5.Town hall discussion of needs identified and strategies for effective advocacy to meet these needs (Participants – 30 minutes) 6.Presentation of data specific to addressing the needs and strategies identified (Dr. Satin and Mr. Miles – 20 minutes)

5. Schedule 7.Open Q and A with closing remarks (Participants and panel – 7.5 minutes) 8.Participants fill out STFM session feedback cards (2.5 minutes)

6. P4P Definition Third party payer or health system awards periodic bonus to clinicians achieving particular quality goals. 1. Foubister, Vida. “Issue of the Month: Pay-for-Performance in Medicaid” The Commonwealth Fund. Accessed 8/29/05 http://www.cmwf.org/publications_show.htm?doc_id=274106

7. The Charitable Interpretation of P4P P4P reimburses physicians for providing quality care, and finances quality improvement innovations.

8. The Skeptical Interpretation of P4P P4P enables third party payers to control costs by bribing physicians to follow prescribed practice patterns.

9. Quality goals may be in areas of: 1.Structure: e.g. Having an electronic medical record 2.Process: e.g. Adherence to professional guidelines such as checking a hemoglobin A1c every 3 months in patients with DM2 3.Outcomes: e.g. Hemoglobin A1C <7.0 in patients with DM2 2. Outcomes-Based Compensation: Pay-For-Performance Design Principles, 4th Annual Disease Management Outcomes Summit, Johns Hopkins / American Healthways, Nov. 2004

10. Who sets the goals? P4P programs vary by third party payer or health system. Some require a 90% childhood vaccination rate, others 80%. Some goals vary annually based on last year’s top clinics’ results. Some require personal improvement over last year’s results. Some restrict their P4P criteria to patients with their insurance. Personal investigation of Minnesota’s major insurers including Medica, HealthPartners, Blue Cross Blue Shield, UCare; interviews, internet search on insurance websites, and internal UMN DFMCH documents, 9/2005.

11. The Money There are >150 P4P programs in the US, the largest being CMS’. Some P4P program “bonuses” truly represent new funds while others represent a 3% “withhold” across the board from the current fee-for-service schedule. P4P reimbursements range from 1.5%-40% of a physician’s fee-for-service reimbursements. Personal investigation of Minnesota’s major insurers including Medica, HealthPartners, Blue Cross Blue Shield, UCare; interviews, internet search on insurance websites, and internal UMN DFMCH documents, 9/2005.

12. The P4P Rationale Physicians change practice patterns in response to changes in reimbursement. Achieving quality measures and adhering to professional guidelines results, on average, in better patient outcomes. 2. Outcomes-Based Compensation: Pay-For-Performance Design Principles, 4th Annual Disease Management Outcomes Summit, Johns Hopkins / American Healthways, Nov. 2004 3. Werner RM, Bradlow ET. Relationship between Medicare’s hospital compare performance measures and mortality rates. JAMA. 296(22):2694-2702, 2006 Dec 13.