Module 5: Provider Incentives

Multi-stakeholder Community Inventory Modules

Community quality collaboratives are community-based organizations of multiple stakeholders, including health care providers, purchasers (employers, employer coalitions, Medicaid and others), health plans, and consumer advocacy organizations, that are working together to transform health care at the local level. The Agency for Healthcare Research and Quality offers these organizations many tools to assist in their efforts.

Your Goals in This Inquiry

  • Identify the nature of provider incentive programs, their goals, structures, results and plans for the future. Include incentive programs for physicians and hospitals.
  • Identify the historical context of provider incentives in your community.
  • Identify the extent to which there is, or is not, alignment of what is rewarded across current programs.
  • Identify the level of interest in an aligned community approach to provider incentives.
  • Identify beliefs about how to provide more meaningful or powerful incentives to providers.
  • Identify how to build or enhance existing provider incentive programs for maximum improvement in health and health care quality.
  • Identify how to build or enhance existing provider incentive programs for maximum improvement in provider efficiency.
  • Identify interest in alignment of provider incentives with consumer incentives and public reporting efforts.

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Information You May Want to Gather

  • Health plan pay-for-performance (P4P) programs
    • Number of plans offering programs; differential national commercial, regional commercial and Medicaid.
    • Number of purchasers offering programs.
    • Number of covered lives represented by plans offering programs.
    • What is specifically being rewarded.
    • Type of providers rewarded.
    • Alignment of programs across plans (requires Community Quality Collaborative analysis).
    • Number and type of programs (conditions, quality, efficiency, patient experience).
    • Maturity or length of time in place.
    • Amount of dollars allocated/percent of payment.
    • Rewards other than payment, such as technology, reducing administrative burden.
    • Number of physicians/hospitals rewarded.
  • www.bridgestoexcellence.org for a program in your community.
  • http://recognition.ncqa.org/ for physician recognition by program and state.
  • http://www.leapfroggroup.org/compendium2 for provider incentive and rewards initiatives by state.
  • Centers for Medicare & Medicaid Services (CMS) demonstration programs in your community. http://www.cms.hhs.gov/DemoProjectsEvalRpts/MD/list.asp
  • Medicaid P4P in your market.
  • Provider views and response to provider incentives programs
    • Public positions.
    • Improvement in performance/quality.

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Key Individuals to Contact

  • Individuals within purchasers who are responsible for pay-for-performance programs.
  • Providers who have participated in CMS provider incentives programs, Bridges to Excellence, and other incentive programs.
  • Quality leaders and business managers of key integrated systems, physician groups, IPAs, hospitals, and health care systems.
  • Individuals within health plans who are responsible for pay-for-performance programs and/or those who contract with providers. Ascertain level of interest by health plan in including Medicaid in P4P programs.
  • Individuals within QIOs who have been responsible for the Doctor's Office Quality — Information Technology program (DOQ IT) for information. about incentives related to health information technology adoption and reporting.
  • Employer coalitions

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Other Individuals to Consider Contacting

  • Labor.
  • Academia, researchers.
  • Entity reporting hospital patient safety.
  • Regional Health Information Organizations (RHIOs)/Health Information Exchanges.
  • State, county, local government (regulatory).

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Suggested Questions

Communitywide Provider Incentives

  • Do the community's provider incentives programs represent a critical mass of patients and critical dollar amounts at stake to motivate behavior change on the part of providers?
  • Is there alignment of incentive program structure (e.g., same measures, same conditions, same provider types) to achieve maximum impact and focus?
  • Do or should measures target specific areas of low quality and/or high cost for your community?
  • Have there been rewards for adoption and use of IT infrastructure?
  • How do providers generally view these programs? What changes would they like to see?
  • Are there payment reform discussions or initiatives underway, e.g., to consider alignment of these programs, medical home, in this community? If so, how do you see them impacting provider incentives programs?
  • Have purchasers of health care for Medicaid, state employees, local municipalities, and others supported provider incentives?
  • If applicable, how would you ensure that rural areas are included in provider incentives activities?
  • Are there geographic issues, such as distances, market service areas, local jurisdictions, or other boundaries, that may pose challenges to implementing provider incentives?
  • Are there demographic issues such as age, income, or education levels that need to be considered when developing incentive programs?
  • Do you see any individual stakeholder as dominant in this market, for example, purchasers, providers, or health plans? If so, how might that impede or support the development of provider incentives?

Stakeholder-Specific Provider Incentives

  • What have you and others in your stakeholder group done in the area of provider incentives so far?
  • What specific programs are in place?
  • What providers and what measures are being rewarded?
  • Who is involved? How should they be involved in the Community Quality Collaborative?
  • Have you aligned your programs with other payers in the market and public reporting measures?
  • What are the lessons learned?
  • What are your goals and plans for the future?

Future Community Quality Collaborative Provider Activities

  • What could your organization contribute to the Community Quality Collaborative in the area of provider incentives?
  • How do you envision being involved in the goals of the Community Quality Collaborative?
  • What should the Community Quality Collaborative set as goals related to provider incentives?

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Compiling Results

Tracking your activities and results of your inventory in a table similar to the one below will be useful for reporting activities to the Leadership Team.

Provider Incentives — Activities and Results
Interviewee NamePosition, OrganizationSummaryConclusions/Next Steps
    
    
    
    
    
    
After data have been gathered from all sources in the focus area, the Focus Area Team Leader and members may analyze the results by reviewing the goals identified at the beginning of this section and by identifying and summarizing the following aspects of the inventory findings with each other and with other Focus Area Team leaders.
Provider Incentives — Analysis
Gaps 
Overlaps 
Opportunities for Alignment 
Challenges 
Lessons Learned 
Resources 
Leaders 

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Consensus Score Card

You may wish to develop a score for your Community Quality Collaborative's stage of development in each focus area to facilitate comparison of its stage of development across focus areas. You may discover differences in scores of individual key stakeholders for the same question. Identifying the degree of consensus among stakeholders will be useful in clarifying differing perceptions and goals and areas where consensus building may be useful for more effective collaboration.

If a quantitative approach doesn't fit in your situation, you may wish to use a more qualitative approach such as identifying areas of strengths and weaknesses or specific challenges and solutions.

  • Ask each team member to answer the following questions on a scale of 1-10 with 1 being the least developed and 10 being the most developed.
  • Average the scores of the team members, for each question, to get an average score per question.
  • Discuss any major differences between team members' scores to gain an understanding of each other's perspectives and knowledge.
  • Total the scores for all the questions and divide by the number of questions to get the score for this focus area.
  • Compare your Community Quality Collaborative's strength in this focus area to its strength in other focus areas in the overall Community Inventory Consensus Score Card when compiling and analyzing overall results from the tool.
Provider Incentives Consensus Score CardSCORE
(1-10)
1. Our community has aligned provider incentives. 
2. The provider incentive programs in our community represent a sufficient critical mass of covered lives — and dollars — to motivate provider behavior change. 
3. Health care leaders in our community support provider incentives. 
4. Some of the Community Quality Collaborative stakeholders have been involved in provider incentives program development, implementation, or management. 
5. The Community Quality Collaborative includes the right stakeholders to advance provider incentives goals. 
6. The Community Quality Collaborative includes the right individuals to advance its provider incentives goals. 
7. The individuals at the table are open to, or are drivers of, innovation. 
8. The individuals at the table are willing and able to advocate on behalf of the Community Quality Collaborative provider incentives goals in their respective organizations. 
9. Members of the Community Quality Collaborative will be able to reach a common vision of the Community Quality Collaborative's role in provider incentives. 
10. The organizations involved in the Community Quality Collaborative are willing to share expertise and capabilities around provider incentives for the benefit of the community. 
11. The organizations are willing to share resources, in-kind, financial or other, in this multi-stakeholder collaborative to advance provider incentive efforts. 
12. There are sufficient resources for this Community Quality Collaborative to achieve its provider incentives goals. 
13. The participants will devote adequate time and resources to the provider incentives goals. 
14. The Community Quality Collaborative will seek outside expertise if needed to achieve its provider incentives goals. 
Total Score 

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Current as of March 2009
Internet Citation: Module 5: Provider Incentives: Multi-stakeholder Community Inventory Modules. March 2009. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/professionals/quality-patient-safety/quality-resources/value/cimodules/cimodules5.html