Question #1:

In your opinion, what are the most significant obstacles to achieving and rewarding provider quality?

I think that there are a few key hurdles that need to be circumvented. First, the widespread adoption of electronic medical records is still years away across the spectrum of the medical delivery system. Therefore, maximizing existing administrative data sets is critical to conducting accurate and systematic population-based assessments of healthcare quality. The creation of a longitudinal administrative record, which includes inpatient and outpatient data, pharmacy prescription information, and dosage and the laboratory results, will create a cost-effective means of ascertaining provider performance for both process and outcomes of medical care. Second, the standardization of quality of care metrics across many different institutions also poses significant challenges. Although it is a worthwhile initiative, there is a risk of falling into the lowest common denominator approach, where institutions with better data may be forced to dump their quality of care metrics because others can not, or do not want to, improve their data collection and integrations systems.

Question #2:

In your opinion, what are the most forward thinking initiatives or solutions that should be widely explored to achieve the systematic change necessary for successful pay-for-performance?

I think we need to engage the practicing physician community to establish a genuine and productive dialogue about how to measure quality of care in a valid, meaningful way. There needs to be a mutual understanding of the limitations of conducting such assessments given the current tools. Likewise, we need to acknowledge that just like many other events in life, compliance and adoption of evidence based guidelines follows a normal distribution. So in general, 20% of providers will perform very well; 60% hover in the middle and the other 20% remain in the lower end of the distribution. Perhaps as payers create more reimbursement differentials based on the quality of output, the incentive to improve performance will be strong enough to promote such dialogue.

Question #3:

Please expand on any initiatives with which you are currently involved that benefit your organization or the health care industry.

Health Benchmarks® Inc. develops and implements pay-for-performance programs for several large health plans throughout the U.S, representing over 25 million members. Our approach has always been to allow any physician to review the detailed algorithms of any given metric; e.g. the codes that make someone fall in a given denominator and/or numerator, and the attribution methodology. Because we've essentially opened the "black box", HBI has been able to achieve significant physician buy-in for our methodology. Furthermore, HBI also aims to evaluate the effect of pay-for-performance programs, by conducting health services research, which we are co-authoring with some of the physicians impacted by these programs. By publishing our researching findings in peer reviewed journals, HBI widely shares its lessons learned with its colleagues throughout the country.

Question #4:

Please provide highlights of your presentation at the Leadership Summit and any preliminary results or data that can be shared.

In an effort to address the evidence gap among populations with less restricted coverage, a quality-based physician incentive program was implemented in a preferred provider organization (PPO) setting. We examined the extent to which appropriate care, as determined by 11 quality indicators, is affected by providers who participate in a quality-based physician incentive program compared to providers who choose not to participate in such a program.

The results not only provide support for the use of quality-based physician incentive programs, but also provide a means for achieving a higher level of quality care in these populations, given that PPOs are increasingly playing the role as the plan of choice in the U.S.

Question #5:

Please state what you hope to achieve by participating in the 3rd Annual World Congress Leadership Summit on Health Care Quality and Pay for Performance Contracting.

I am looking forward to meeting with other leaders in the pay-for-performance arena, and I am hoping that the conference enables us to exchange information, experiences, and insights for advancing and enhancing pay-for-performance initiatives.