Successful Contracting and Incentives for Improved Performance with Hospitals, Group Practices and Independent Physicians

Harvard Pilgrim Health Care – Group Practices and Independent Physicians

• HPHC’s initiatives in pay-for-performance contracting
• Selection of provider quality metrics
• Building a comprehensive incentive structure – Successful models to improve performance
• Tailoring rewards to a diversified network – from independent practices to integrated provider networks
• Incorporating objectives from “Bridges to Excellence” in incentive design
• Public reporting of provider quality measures

CMS Demonstration Project – Measuring, Reporting and Rewarding Hospital Quality In mid-2003 Medicare is launching a three-year project with the Premier, Inc., an alliance of hospitals and health systems, to demonstrate the value of financial incentives and public performance ratings in spurring healthcare quality improvement. Medicare will provide additional bonus reimbursement to participating hospitals ranking in the top 20 percent of the pilot group in specified clinical areas and publicly report top performers. Standard measures being used to score performance are taken from the Premier alliance’s large comparative database, in which all pilot hospitals participate.

• Making the business case for high quality
• Defining clinical excellence and developing metrics – A derivation of standard quality measures agreed to by clinicians, accepted by payers and understood by the public
• Building the clinical database, reporting system and application among approximately 500 hospitals
• CMS' public reporting and pay for quality efforts -- Pay-for-Performance demonstration project status
• Quality indicators and performance measures used for nursing homes, acute care hospitals and other venues of care
• Public reporting to provide consumers, purchasers and providers with meaningful data about whether care is safe, timely, patient-centered, beneficial, equitable and efficient
• Results to date of public reporting

Kenneth W. Kizer, M.D., MPH, President and CEO, National Quality Forum
Roberta Herman, M.D., Senior Vice President and Chief Medical Officer, Harvard Pilgrim Health Care
Richard A. Norling, Chairman and CEO, Premier, Inc.
Barbara R. Paul, M.D., Director, Quality Measurement and Health Assessment Group, Centers for Medicare & Medicaid Services