1. Pay for Performance Macaran Baird, MD, MS Professor and Head
University of Minnesota
Department of Family Medicine and Community Health
University of Minnesota Medical Center Family Medicine Residency Program / Smiley’s Clinic

2. State of Minnesota is adopting P4P to direct care to top performing clinics.

3. MN Dept. of Employee Relations
Started P4P with 4 tiers of performance
Applies to all state employees
Increased co-pays for clinics with decreased performance

4. Data problem will exist for sometime
Some systems use billing data that can be inaccurate
Chart audits are often flawed and expensive
Works best if based upon patient registries

5. Chronic-Disease-Management Results
Patients
Used asthma medications 71% 74% 76% 91%
Kept blood pressure <140/90 57% 60% 64% 68%
Used depression medications 49% 51% 49% 42%
Met diabetes 1 (looser targets) 12% 12% 16% 20%
Met diabetes 2 (tighter targets) NA 4% 6% 9%
MN Community Measurement Project

6. Top Scoring Clinics Adult asthma treatment Cancer screening combo
Lakeview Clinic: 99% ages 5-56 were enrolled and had appropriate medications
Cancer screening combo
HealthPartners Medical Group: 65% ages were up to date on all appropriate cancer screenings
High blood pressure
Mayo clinic: 86% ages with high blood pressure had it under control

7. Childhood vaccinations
Mayo Clinic: 95% ages 2 and under received vaccinations
Chlamydia screening
United Family Practice Health Center: 62% of sexually active women ages had a test for chlamydia

8. Diabetes care Depression treatment
Camden Physicians and Winona Clinic: 23% with diabetes ages achieved 5 treatment goals
Depression treatment
Sioux Valley Clinic: 63% ages 18+ diagnosed with new depression episode were treated with antidepressants and had 3 follow-ups

9. Medicare quality pilot program planned
3-year demonstration to compensate physicians for care to patients with chronic conditions
Physicians must be in small or medium practices and provide care to 50 Medicare patients
They will submit data annually on 26 quality measures
1st year: “pay for reporting” to establish baseline measures
Subsequent years: practices earn $ based on performance on quality measures

10. IOM urges Medicare to adopt pay for performance
Institute of Medicine released a report in 9/06 recommending a pay-for-performance system
Current system of fee for service encourages volume rather than efficiency and quality
Congress should reduce base Medicare payments and use money saved to fund P4P
Report acknowledges fewer than 20 studies about P4P which came to differing conclusions about its effectiveness

11. For Department of Family Medicine and Community Health
Next $500,000 in income from practice can arrive via P4P or adding 5,000 visits!
Therefore, we’re learning to reach P4P targets, clarifying our data, and improving care