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The Business Case for P4P

The Business Case for P4P. Douglas Allen MD., MMM. Chief Medical Officer Greater Newport Physicians IPA. What P4P Incentivises. Changes Directly Inventivised. Information systems to house clinical data Disease Registry Creation

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The Business Case for P4P

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  1. The Business Case for P4P Douglas Allen MD., MMM. Chief Medical Officer Greater Newport Physicians IPA

  2. What P4P Incentivises

  3. Changes Directly Inventivised • Information systems to house clinical data • Disease Registry Creation • Clinical Quality Reports and Physician reminders (retrospective) • Point of Care Physician Reminders • Improved Access, Physician Communication and Specialty Care

  4. Changes Indirectly Inventivised • Alternative uses of a Data Warehouse: Understanding Cost Trends • Using Data to Reach out to Members. Education and/or Marketing • EMR Development – Most Effective Strategy to Decrease Errors and Improve Efficiency/Effectiveness

  5. Changes Indirectly Inventivised • Innovative Patient Engagement Strategies, to Further Improve Disease Control. • Innovative Scheduling Strategies. Possibly Doing Away with Scheduling Altogether. • Innovative Patient Communication Strategies. Online Consults, Email etc.

  6. The Ideal State • Patient Centered Health Care. Patient Efficiently Interacts with all Members of the Health Care Team. Contextually Sensitive Educational Tools, Sent to the Patient Through Medium of Their Choosing. • Information Available at the Physician’s Fingertips, Including Insurance Guidelines, Guidelines for DM, Preventive Care and New Technologies. • Full Relational Database at Group Level, to used for both QI and Cost Control.

  7. Ideal State (Cont.) • Point of care support for Physicians, Including Drug-drug Interactions, Medication Compliance, Labs etc.. • Physician Offices have Re-designed Work Flow to Flex to Individual patient Needs, Including use of Educational Aids, Planned Visit Tools, Group Visits etc. • Health Care Providers have Access to Health Related Patient Activity Regardless of Location Within the Community.

  8. Progress Toward the Ideal • Relay Health, Individual Medical Group (e.g. Bristol Park) and other Strategies to Improve Patient Communication. • Numerous Vendor Strategies to Improve Physician Point of Care Support. Quest, Access Express, Physicians Web Link, Physician Associates etc. • Numerous Groups Building Clinical Data Warehouses or Relying on Vendors to Jumpstart Their Efforts. • BCCP Experiments, Demonstrating Applicability and Effectiveness of Office Re-design in the California Market Place.

  9. Progress (cont.) • RHIO Concept put forth by David Brailer. Would Allow All Health Care Providers to Know about Health Related Activity for Every Patient Regardless of Location. • Wave of Advanced Access Pilots with and without Health Plan Support • Groups using their own Data Warehouses for Utilization Management, but Lack Benchmarking • Clinical Data Repository by CAPG. A Benchmarking Solution.

  10. Reminder of last year’s Pay-out by health plan Plan 1 $0.25 Plan 2 $0.78 Plan 3 $0.94 Plan 4 $1.30 Plan 5 $1.38 Plan 6 $1.89

  11. Investment Cost Ladder Electronic Medical Record (Group) $$$$ Electronic Medical Record (Practitioner) Dz Specific Case Management $$$ Real Time Decision Support $$ Dr Financial Incentives Internal Data Warehouse $ Patient Reminders Patient Negative lists Dz Registry Through Vendor

  12. GNP I.S. STRATEGY • Challenge : to Weave Together Many Applications and Solutions into a Single, Coherent, Overarching Strategy

  13. Future Strategies • Online EMR • Connectivity with a RHIO • Advanced Access

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