In an atmosphere of shrinking reimbursements, one way to invigorate physician practice revenues is by participation in pay for performance (PFP) programs sponsored by CMS, Bridges to Excellence and others. Following their leads, many health plans, payors and purchasers are proposing PFP to providers to raise the bar on healthcare quality, accountability, access and outcomes and reduce unnecessary healthcare costs.

While PFP can substantially enhance a provider's efficiency, potential PFP partners must tune into the needs and values of physicians to build buy-in and better ensure the success of the quality improvement initiative.

In Engaging Physicians in Pay for Performance: Promoting Partnerships That Align Data, Dollars, Care & Quality, two industry leaders chronicle the development of mutually beneficial provider-plan partnerships in PFP. They identify practice workflow issues that can derail physician participation in PFP and provide inside details on how they have engaged physicians in PFP programs and sustained motivation for continued participation.

In this 47-page report, learn how participation in CMS' three-year physician group practice Medicare demo provided the framework for Alegent Health to realign disparate methodologies, tools and resources in use by its 1,200 physicians at nine hospitals. By building a PFP initiative based on awareness, education and intervention, Alegent Health makes medical staff more accountable for clinical outcomes and performance.

This report also documents the evolution of HealthSpring's successful PFP partnership from a single 13-physician effort to a 12-group collaborative of 150 doctors caring for 9,000 Medicare members. Together, HealthSpring and its physicians chose performance indicators in the common domain and ultimately improved compliance in key clinical measures — such as those for diabetes — and reduced avoidable ER visits.

Engaging Physicians in Pay for Performance: Promoting Partnerships That Align Data, Dollars, Care & Quality also provides the results of HIN's 2007 e-survey on pay for performance initiatives in the healthcare industry — reflecting the PFP experience from 157 health plans, providers and employers.

Presenting PFP case studies from their own organizations are Dr. Fred Hosler, senior vice president and chief medical officer at Alegent Health, and Mike O'Neill, vice president of strategy with HealthSpring. Supplementing these success stories are physician engagement tactics from Lorraine K. Larrance, consulting senior manager with Pershing Yoakley & Associates, P.C., who identifies key barriers to physician participation and proposes strategies to overcome them.

This report provides details on:

• Evolving the physician partnership to include the sharing of outcomes success with physicians;
• Using bottom line impact to get physicians' attention;
• Aligning PFP data, dollars and care support by connecting initiatives to improved patient care and outcomes;
• Building credibility by appropriate use of point-of-care data;
• Developing incentive-based communication and training that educate and motivate physicians and staff;
• Cultivating physician champions to design the PFP program and sell it to colleagues;
• Understanding factors that can influence physician buy-in to quality-based payments and how to address them;
• Positioning PFP as a clear member benefit;
• Keeping physicians focused on the PFP path toward quality improvement;
• Pay for Performance in 2007: A Promising Model Faces Challenges: 157 healthcare organizations describe the impact of current PFP programs and the challenges inherent in these healthcare improvement initiatives.

Table of Contents

• Keys to Engaging Physicians in PFP Programs
  • A Focus on Quality
  • Identifying the Issues
  • Making the Medical Staff Accountable
  • Focusing on the Core Measures
  • The Elements of Engaging Physicians
  • Educating the Key Players
  • Case Studies: Seeing the Results
• Data, Dollars & Care Support: Keys to Better Outcomes
  • Critical Components to Address
  • Improving Quality & Services Results in Improved Outcomes
  • Do No Harm
  • The Cost of Quality Care
  • Aligning the Data is Key
  • Aligning the Dollars
  • Telephonic Support
  • Examining the Results
  • Clinical Measures for Chronic Conditions
  • Financial Impact Through Utilization
  • Communication Strategies
  • Maintaining Momentum
• Pay for Performance in 2007: A Promising Model Faces Challenges
  • The Health Plan Perspective
  • Impact of Programs Vary Widely
  • Provider Buy-in Poses Biggest Challenge
  • The Provider Perspective
  • Providers Report Quality Improvements
  • Cash Common to Encourage Buy-in
  • The Employer Perspective
  • Obtaining Quality Data Biggest Challenge for Employer Respondents
  • The Future of PFP Programs
  Q&A: Ask the Experts
  • PFP Physician Buy-in
  • Launching an EMR
  • Physician Leadership Initiative
  • Provider Participation in PFP
  • PFP Plans
  • ROI in PFP
  • Identifying Champions
  • Overcoming Resistance
  • Hiring the Right Person
  • Physicians’ Messages
  • More Patients Turning to Quality Data
  • Motivational Strategies
• Glossary
• For More Information
• About the Authors