Performance Contracting: Are you ready?

Reduce Waiting & No-Shows Increase Admissions & Continuation www.NIATx.net

Reduce Waiting & No-Shows Increase Admissions & Continuation

Performance Contracting: Are you ready?

Jay Ford, Ph.D.Director of Research, NIATx

June 2010


ONDCP

• Performance Contracting for State Treatment Systems– Work at the state level to incentivize

providers to get results– Pilot Project ($6 Million)

• Enhance Drug Treatment Quality• Incentivize providers to achieve specific

performance targets


Key Lessons Learned: Pay for Performance

• Building the system

• Pilot testing

• Offering the right type of incentive

• Overcoming potential obstacles

• Implementing strategies for long-term success and sustainability


Building the system• Involve staff who can examine associated

planning, financial, and legal issues.• Determine incentive types, develop targets,

and provide feedback reports.• Will a contractual set-aside or grant funds pay

for the incentives now and in the future?• How often are the rewards or penalties

administered?• Who does monitoring and who informs

providers of penalties?


Pilot Testing

• Pilot test the system before statewide rollout:– Involve only a core set of providers.– Allow providers to review contract changes.– Eliminate accountability for improvement

changes (good or bad) for the first six months.


Incentives• When deciding how to pay for the

incentives, you need to consider:– Will you pay for the incentives with a

contractual set-aside? – Will you pay for the incentives through

existing grant funding?– What is your plan for ongoing financial set-

asides to pay for the incentives?


Incentives• Offering the right type of incentive:

– Treatment Provider Incentives

– Data collection incentives

– Spreading process improvement


Incentives

• The incentive and reward structure is based on the measure

• Regardless of the type of provider incentive, it must – be meaningful, – achievable, and – minimize provider data collection burdens.


Potential Obstacles

• Lack of valid and practical quality measures

• Linking incentives to specific outcomes• Unwillingness or inability of providers to

collect data• Validity of the data used to calculate the

incentive measures


Implementation Strategies

• Develop valid and practical measures.• Offer incentives meaningful to providers.• Ensure the data is easily obtainable and

minimize reporting burden.• Customize the system to the way

providers do business.• Provide training on how to use data

effectively.


Contracting• When making legal and binding changes

to contracts, you need to consider:– How do they get settled?– How often are the rewards or penalties

administered?– Who does monitoring and who informs

providers of penalties?– Did you seek approval of the contract

changes through legal?


References• Bremer, R.W., Scholle, S.H., Keyser, D., Houtsinger, J.V.K. & Pincus,

H.A. (2008). Pay for Performance in Behavioral Health. Psychiatric Services 59(12):1419-1429.

• McClellan, A.T., Kemp, J., Brooks, A., Carise, D. (2008). Improving public addiction treatment through contracting: The Delaware Experiment. Health Policy 87: 296-308.

• Pelonero, A.L. & Johnson, R.L. (2007). A Pay-for-Performance Program for Behavioral Health Care Providers. Psychiatric Services 58(4):442-444.

• Shen, Y. (2003). Selection Incentives in Performance-Based Contracting System. Health Services Research 38(2):535-552.

• Shephard, D.S., Calabro, J.A.B., Love, C.T., McKay, J.R. et al. (2006). Counselor Incentives to Improve Client Retention in an Outpatient Substance Abuse Aftercare Program. Administration and Policy in Mental Health and Mental Health Services Research 33(6):629-635.


For further information, please visit

www.niatx.net

www.odmhsas.org/data

Contact Information

Jay Ford, [email protected]

Documents

Performance Contracting: Are you ready?