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State Level ChangeState Level ChangeIntroducing P4PIntroducing P4P
NIATx/SINIATx/SI
Interest Circle CallInterest Circle Call
June 10, 2010June 10, 2010
Context for ChangeContext for Change
Health Care Arena – Addiction is a HEALTH Health Care Arena – Addiction is a HEALTH problem:problem:
Part of mainstream healthcarePart of mainstream healthcarePart of Health Care ReformPart of Health Care Reform
Chronic not acute condition:Chronic not acute condition:As a chronic disease, purchasers will need to modify their As a chronic disease, purchasers will need to modify their contract approaches, funding mechanism, and expectationscontract approaches, funding mechanism, and expectationsTreatment programs will need to change from acute to chronic Treatment programs will need to change from acute to chronic care design and service delivery models care design and service delivery models
Changes in Funding/ContractingChanges in Funding/Contracting
New financing and funding models for New financing and funding models for healthcare and SA treatment:healthcare and SA treatment:
Fee for service, grant and contract funding Fee for service, grant and contract funding do not reward performance and resultsdo not reward performance and resultsBundled care, networks and collaborativesBundled care, networks and collaborativesPay for for resultsPay for for results
Models:Models:Pay for Performance (P4P)Pay for Performance (P4P)Accountable Care Organizations (ACO’s)Accountable Care Organizations (ACO’s)Episode-based FundingEpisode-based Funding
Operational DefinitionsOperational Definitions
PerformancePerformance
““Accomplishment of a given task measured against Accomplishment of a given task measured against standards …” standards …” (Business Dictionary. com)(Business Dictionary. com)
““The way in which somebody does a job, judged by The way in which somebody does a job, judged by its effectiveness; often used before a noun as in its effectiveness; often used before a noun as in ‘performance-related pay.’” ‘performance-related pay.’” (Encarta Encyclopedia)(Encarta Encyclopedia)
For healthcare – related to expected results For healthcare – related to expected results produced by effective care and management produced by effective care and management practices; generally treatment processes or proximal practices; generally treatment processes or proximal outcomes that are not beyond the provider’s control.outcomes that are not beyond the provider’s control.
Operational DefinitionsOperational Definitions
Performance ManagementPerformance ManagementUses data to:Uses data to:
Assess system and program strengths and Assess system and program strengths and weaknessesweaknessesAnalyze and interpret provider performance on Analyze and interpret provider performance on key areas of interest/importancekey areas of interest/importanceProduce data-based reports to understand and Produce data-based reports to understand and monitor system and individual program monitor system and individual program performanceperformance
Operational DefinitionsOperational Definitions
Performance Management (Con’tPerformance Management (Con’t))Uses data to:Uses data to:
Target quality improvement effortsTarget quality improvement effortsProvide regular feedback to individual providers Provide regular feedback to individual providers to help them understand their own performance to help them understand their own performance and to compare it with statewide standards and and to compare it with statewide standards and other similar programsother similar programsPrepare public scorecards on selected Prepare public scorecards on selected measuresmeasures
Operational DefinitionsOperational Definitions
Performance-based ContractingPerformance-based ContractingIncludes data based performance expectations Includes data based performance expectations
and individual program contractsand individual program contracts::
Select measures applicable to all programs or specific Select measures applicable to all programs or specific modalities or individual programs (for specialized types modalities or individual programs (for specialized types of services, or to correct specific program deficiencies)of services, or to correct specific program deficiencies)Use data to gauge program performance, identify Use data to gauge program performance, identify successes, and determine when technical assistance is successes, and determine when technical assistance is needed to improve performance.needed to improve performance.
Operational DefinitionsOperational Definitions
Pay for Performance Pay for Performance ContractingContracting
““A remuneration arrangement in which a portion of A remuneration arrangement in which a portion of the payment is based on performance assessed the payment is based on performance assessed against a defined measure. Another component of against a defined measure. Another component of the remuneration is independent of the amount at the remuneration is independent of the amount at risk.” risk.” ((Congressional Research ServiceCongressional Research Service))
Applied to a few very carefully selected measures Applied to a few very carefully selected measures or targets that are of particular importance at a or targets that are of particular importance at a particular time for service improvement, or to meet particular time for service improvement, or to meet a particularly critical need or goal.a particularly critical need or goal.
Purpose of P4PPurpose of P4P
Incentive programs promote performance and Incentive programs promote performance and quality improvementquality improvement
Tools to encourage change and reward resultsTools to encourage change and reward results
P4P is not a magic bullet – it is one of a number P4P is not a magic bullet – it is one of a number of activities that can work to improve healthcare of activities that can work to improve healthcare quality and change the way it is delivered and quality and change the way it is delivered and financed.financed.
Promote Collaboration Not Promote Collaboration Not CompetitionCompetition
Design P4P system to require collaboration Design P4P system to require collaboration among providers, including continuity of care among providers, including continuity of care i.e., movement from one level of care or one i.e., movement from one level of care or one setting to another as well as continuing caresetting to another as well as continuing care
Include rewards for collaboration with other Include rewards for collaboration with other providers in across treatment systemsproviders in across treatment systems
