PBGH, Physician, and Consumer Leaders Endorse Medicare Payment Reform

Citing California as a model where diverse stakeholders have successfully worked together to improve care for patients and engage physicians, industry leaders urge Congress to consider core elements for Medicare "value purchasing" reform that would advance value and performance accountability.

Necessary components for critical reform include:

• Measurement of performance that can be quickly implemented, by starting with measures currently in use, fairly adjusts for physicians' patient populations where appropriate, is centered on patients' needs and experiences, and is usable by physicians to improve care they deliver.
• Performance-based payments as part of an overhaul of the annual physician fee schedule.  Performance-based payments should grow over time, becoming an increasingly substantial portion of physician payments, initially rewarding for agreement to participate, and then for both performance and improvement; and
• Performance reporting that provides feedback to physicians on their own performance, with a progression to public reporting that provides as full and fair a picture as possible of physicians' performance and improvement. 

This statement was groundbreaking by having PBGH joined by the California Medical Association (CMA) and the California Association of Provider Groups (CAPG), two organizations representing over 35,000 physicians in California, as cosigners.   The group agrees that moving to robust measurement, substantial performance-based payments, and full public reporting should be done as rapidly as possible, while ensuring that implementation is done correctly and incrementally.  Read more.  

Purchasers Consider "Promises and Perils" of High Deductible Health Plans

At the recent PBGH Board of Directors Retreat, leading healthcare purchasers discussed the strategic approaches to benefit design now being propelled by the Medicare Modernization Act: health savings accounts and high deductible health plans.  The group recognized the potential opportunity for engaging consumers, aligning incentives for healthy lifestyle choices, and informed decision-making.  At the same time, the group expressed sensitivities to the potential impact of a high deductible health plan on select populations, specifically the lower income and chronically ill.  The discussion was framed by considering the "Net Present Health Value", i.e. present and future health gains resulting from benefit designs adopted today.  "Net Present Health Value" underscores purchasers' desire to more effectively measure longer term clinical impact, productivity, impact on health from consumer lifestyle change, and migration to higher value providers.  The discussion generated broad recommendations of "Dos" and "Don'ts" for purchaser consideration in plan design.  Read more. 

PBGH Releases Reports on Physician Performance Measurement and Incentives

Two meetings critical to the national agenda of physician performance transparency and performance-based compensation are summarized in recently released PBGH reports. 

"Using Administrative Data to Assess Physician Quality and Efficiency" outlines quality measures that address structure, process, and outcome metrics currently in use.  Commercially available cost efficiency software measures relative use of resources after defining episodes of care, considering attribution, and adjusting for risk. Additionally, stakeholders are collaborating to overcome recognized data issues.   An array of national initiatives are engaged in the development, endorsement, or deployment of standardized measurement intended to promote transparency, continuous quality improvement, and performance-based compensation for physicians.

"Aligning Physician Incentives" documents agreement by a diverse group of stakeholders to endorse performance-based payment of physicians.  The California group is closely aligned with the recently adopted consensus statement for Medicare (see above) and cites principles supported by the AMA.  Further, the group reinforced the importance of alignment across payers, use of electronic data, adoption of a comprehensive measurement set to promote systematic change, effective public reporting to consumers, and careful consideration of access issues, especially for challenged patient populations. 

CCHRI Releases the 2005 Report on Quality
California Cooperative Healthcare Reporting Initiative (CCHRI), a statewide measurement and reporting collaborative of health plans, providers, and purchasers managed by PBGH, has released its 10th annual report comparing performance across California health plans and medical groups.  CCHRI promotes comparability of results by providing a single process for the collection and analysis of California quality of care and member experience data.

Among other improvements, the report indicates that cholesterol control in patients with diabetes and in patients with an acute cardiovascular event has improved.  In fact, since 1999 an additional 164,000 diabetics and 6,700 people recovering from an acute cardiovascular event demonstrated improved levels of cholesterol control.  Additionally, patients' overall experience and satisfaction with their health plan ratings have increased. 

This year's results are publicly available at healthscope.org and opa.org.

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