Record Detail

PROGRAM SPONSORSHIP Formal name of the incentive and/or reward program initiative (if applicable) Program name Partners in Quality Programs: Partners in Excellence and Partners in Progress Program sponsor(s) and parent organization of sponsor(s), if applicable Program sponsor(s) Babette Apland, Senior Vice President, Health and Care Management Parent organization HealthPartners Primary program contact information Name Kathy Ohmann Title Sr. Director, Health Plan QUI Organization HealthPartners Email Kathy.I.Ohmann@HealthPartners.com Phone 952-883-5702 Sponsoring organization type Multiple Sponsors Employer/health plan coalition Source of funding associated with program set-up costs Funding source Funded by program sponsor(s) Percent contributed by sponsor and grant organization % Sponsor 100% Program set-up costs 600000 Source of funding associated with program operations costs Funding source Other Specify Funded through provider withhold Percent contributed by sponsor and by grant organization % Sponsor 100% Program operations cost 700000 Start date & end date of the program Start Date 01/01/1997 End Ongoing   PROGRAM SCOPE Geographic scope of program Minnesota, Wisconsin Individuals affected by program as a percentage of total population, if known Employer/commercial health plan- active workers Employer/commercial health plan- dependents Employer/commercial health plan- retirees Medicaid Medicare Coverage of affected individuals (for purchaser sponsors only) HMO HMO/POS PPO Indemnity Consumer-Driven Health Plan (CDHP) Plan product(s) the program applies to (for plan sponsors only) HMO HMO/POS PPO Indemnity Consumer-Driven Health Plan (CDHP) Direct target(s) of your program's incentives/rewards Hospital type General Specialty- Cardiac Specialty- Orthopedic Specialty- Surgical Specialty- Women's Academic hospital(s)- American Association of Medical Colleges (AAMC) member(s) Hospital unit Individual Physician type PCPs Specialists Indicate the specialities Diagnostic Radiology, Emergency Medicine, Family Practice, Geriatric Medicine, Internal Medicine, Obstetrics & Gynecology, Orthopedic Surgery, Psychiatry Physician unit Medical group, Independent Physician Association (IPA) Consumers- employer covered lives (for employer respondents only) Other Specify Does not apply Consumers- health plan enrollees (for health plan respondents only) HMO HMO/POS PPO Indemnity Consumer-Driven Heath Plan (CDHP) Medicare Medicaid Health plans (for employers that reward plans only) Other Specify Does not apply Recruitment of program targets Mandatory- all members of target group that meet certain criteria PROGRAM PERFORMANCE MEASURES Clinical/Safety Performance Inpatient clinical and safety measures included in your program Measure sources AHRQ Quality Indicators JCAHO Core Measures The Leapfrog Group Quality and Safety Measures (NQF-endorsed Safe Practices for Better Healthcare) Other NQF Measures IHI 5 Million Lives Campaign Other Specify Specific areas of focus for individual hospitals such as Safest in America; CPOE Measure areas Cardiac Acute myocardial infarction (AMI) Congestive heart failure (CHF) Other Specify Delays in Care, Surgical Infection Prevention Cancer Other Specify Delays in Care Neurosurgery/Neurology Other Specify Delays in Care Obstetrics-Gynecology Cesarean-section delivery Vaginal birth after cesarean-section (VBAC) Other Specify Delays in Care, Inpatient Neonatal Maternity, Third and Fourth Degree Lacerations Orthopedics Other Specify Delays in Care Pulmonary Adult asthma, Community-acquired pneumonia (CAP) Safety Adverse drug event rate NQF's 27 hospital safe practices (Leapfrog) Prophylactic antibiotic use pre-surgery Surgical infection rate Other measurement areas IHI 100K and 5 Million Lives Campaign measures, Avoidable Hospital Delays Outpatient clinical and safety measures included in the program Measure sources Ambulatory care Quality Alliance (AQA) HEDIS (clinical components) Other Specify Clinical Indicators, Consumer Choice Experience Measures Measurement areas Cardiac Coronary artery disease (CAD) Other Specify Heart Failure Cancer screening Breast Cervical Colon Pulmonary Other Specify Does not apply Safety Other Specify Use of Well Proven Medications Other measurement areas Diabetes Mental health/substance abuse Adult Preventive Care Pediatric Preventive Care Other Specify Healthy Lifestyles, Pharmacy, Patient Satisfaction, ENT, Orthopedics, OB/GYN Health information technology adoption measures Adoption of inpatient HIT CPOE Decision support (e.g., alerts, reminders or point-of-care guidelines) Adoption of outpatient HIT Patient tracking (e.g., managing patient data) Registry functions tracking (e.g., clinical data repository) Decision support (e.g., alerts, reminders or point-of-care guidelines)   In development Patient-Centeredness Patient-centeredness measures Patient-centeredness performance measure sources Resource Utilization and Cost Resource utilization Pharmaceutical usage- formulary compliance Other Specify Behavioral Health and Physical Therapy: Average Number of Visits Per Patient Cost Other Specify In development Health plan performance measures Health plan measures Other Specify Does not apply Performance measure weighting Clinical performance % or N/A 34% Safety % or N/A 49% HIT adoption % or N/A 5% Patient-centeredness (i.e. HCAHPS) % or N/A 2% Other Specify 10% Consumer measures Enrollment and/or participation in risk reduction program Nutrition/weight management Smoking Enrollment and/or participation in risk management program Low back pain Enrollment in high-value health plan Other Specify Does not apply Additional details about your incentive/reward performance measurement mix Partners in Quality Our umbrella pay for performance program, entitled Partners in Quality (PIQ), is composed of two parts described below. Through PIQ we have demonstrated significant and continuous quality improvement results each year through an innovative combination of leading-edge quality measurement, payment methodologies that create a direct relationship between payment levels and providing increasingly high-quality care, and a strategy of engaging with our provider community to change the paradigm in which care is delivered. The programs have significantly improved the health of our members and our community, helped manage cost trends and significantly improved the experience of our members. The goals of the PIQ program are to: • Increase the incidence of perfect care – meaning care that is patient/member centered, timely, effective, efficient, equitable and safe; • Provide public and financial recognition to medical groups for superior performance • Reinforce the principles of prevention, population-based care, evidence-based decision making and continuous process improvement in health care. PIQ has two programs, Partner in Excellence (PIE) which is the bonus component and Partners in Progress (PIP) which is the withhold component. Partners in Excellence PIE, which was launched in 1997, offers graduated financial rewards to primary care and specialty clinics that achieve superior or excellent results in effectively promoting health and preventing disease, based on the enterprise-wide quality goals. Annual financial bonuses tied to these goals, which HealthPartners reviews and updates annually, keep incentives aligned to sustain continuous progress toward perfect care. Annual stretch targets are set high but are achievable. PIE is distinctive among similar programs because it rewards physicians for improving actual clinical outcomes, not simply improved processes. The clinical targets are comprehensive, rather than limited to only one or two measures per disease state, and include all important risk factors in each priority clinical area. Through our PIE program we have achieved amazing results: • Tobacco use dropped to an all time low of 15% and children exposed to tobacco smoke surpassed the national Healthy People goal, dropping to under 9 percent. • Cardiovascular risk was systematically lowered in members with diabetes, high blood pressure and those with coronary heart disease, resulting in 100 fewer heart attacks, 140 fewer amputated legs, and 740 fewer people losing eyesight each year. • Providers used safe and well-tested generic medications more often, saving $62 million and ensuring patient safety. Our networks use of generic drugs has increased from 45% to 61% over the past four years, an increase of 36%. Partners in Progress PIP, which was launched in 2001, built upon and complements our PIE Program, and establishes a financial component for quality as an integral part of standard market-based provider payment. PIP pays providers for ever increasing levels quality through standard reimbursement agreements with the health plan. PIP blends both payment for quality and payment for process, into market-based reimbursement rates for primary care providers, specialists and hospitals. PIP agreements are now in effect with all high-volume multi-specialty/primary care medical groups, cardiology and emergency medicine groups, orthopedics and ENT specialists, and obstetricians and gynecologists, and hospitals that account for significant volumes of member encounters. PIP has also includes many providers outside the Minneapolis St. Paul metro area. PIP uses performance measures that are objective, build upon existing quality indicators, are based on evidence –based standards of care, and which do not impose the burden and cost of significant additional measurement requirements on providers. The PIP strategy is to negotiate individual quality and safety improvement goals with providers that are both meaningful and achievable, and chart a path for incremental performance improvement over time. Through our PIP program we have achieved significant results such as: • Successful completion of service agreements between primary care and cardiology providers to support integrated care for members with congestive heart failure. • Provider enrollment with the Minnesota Immunization Information Connection (MIIC) which is a program among health care providers, parents, public health agencies, and schools aimed at preventing disease through immunization and uses a confidential, computerized information system that contains a complete and accurate record of immunizations, no matter where a patient received the immunization. • Developing criteria for appropriate use of high tech cardiology imaging, which providers groups implemented resulting in increased patient safety and lowered overall costs. • Successful implementation of Rapid Response Teams from the IHI 100,000 Lives initiative resulting in quicker response time to critical patients, thus saving lives. • Successful implementation by hospitals of evidence-based guideline and practice protocols that lead to improved outcomes and a reduction in other unnecessary and more expensive treatments. For example: a) guidelines for appropriate use of CT and MRI imaging; b) an integrated approach to the management of heart failure patients that spans primary care, cardiologists and hospitals; c) a process for reducing potentially avoidable, and potentially dangerous, inpatient days; d) use of smart pumps with appropriate training in all medical/surgical units complete with performance provided to set future improvement goals; e) increased performance on the JCAHO AMI, heart failure and pneumonia core measures; and, f) implementing computerized physician order entry throughout the hospital. Data Reliability Sources of data Existing or new data Existing data sources, New data collected explicitly for program reporting Data type Administrative in origin (derived from claims data) Medical record data Self-reported Other Specify Member Survey Results Data extracting entity Other Specify Independent entity, program target, and outside entity, such as Leapfrog and JCAHO Data aggregator/analyzer Other Specify Independent entity, program sponsor and program target Ensures data accuracy Yes Means of ensuring accuracy Auditing Specify who audits and how often Program sponsor conducts annual audit Self-attestation as to accuracy Specify who does the self-attestation, e.g. CEO Program target Other Specify External NCQA certified auditor Risk-adjustment mechanisms used None of the above INCENTIVE/REWARD CHARACTERISTICS Start date & end date of the incentive/reward Start Date 01/02/2007 End Date 12/31/2007 Structure of the incentive or reward Direct financial reward- increased payment Lump-sum bonus Indirect financial reward Publicize good performance Support for HIT infrastructure improvement Target audience for publication of performance To consumers To plans To provider peers To purchasers Direct financial penalty Differential reimbursement for physicians/hospitals Withhold/performance guarantee tied to performance goals Indirect financial penalty Publicize poor performance Target audience for publication of performance results (check all that apply) Target audience for publication of performance To consumers To plans To provider peers To purchasers Non-financial reward Other Specify In development Upper reward limit $26.5 million Structure of the incentive or reward for programs targeted at consumers Financial reward - direct Other Specify Does not apply Financial penalty - direct Other Specify Does not apply Average monetary consumer incentive Partners in Quality Programs are not directed at consumers. Scoring used to determine payment Absolute goals- patient level measures Pay for meeting one overall measure/group of measures Pay for meeting specific sub goals related to overall measure/group of measures Absolute goals- population level measures Pay for meeting one overall measure/group of measures Pay for meeting specific sub goals related to overall measure/group of measures Other Pay for reporting Frequency of reward or penalty Quarterly Annually Time lag between measurement and receiving reward/penalty One - three months Three - six months Greater than six months Total dollar amounts awarded during the most recent calendar year $20.6 million Source of financial payments for meeting performance goals Current budget redistributed Shared savings breakdown (percentage should add to 100) if applicable Additional details about the incentive/reward characteristics and scoring methodology The Partners in Excellence program provides financial recognition to provider groups who meet established performance goals on specific quality and patient satisfaction criteria. A potential bonus pool is established for each participating provider. A percentage of the bonus pool is attributed to each of the program criteria, and each criteria has an "excellent" and "superior" performance target. Providers can achieve 100% of the bonus pool percentage if the "superior" target is met, or 25% of the bonus pool percentage if the "excellent" target is met for each of the individual criteria. In 2007, the bonus pool percentage assigned to each of the six clinical criteria was 13.5% and the patient satisfaction criteria was assigned 19% of the total bonus pool. COLLABORATION CHARACTERISTICS Phases of program where sought target collaboration Program design and creation Program operations Characteristics of pre-implementation target feedback Provider participation in program design Cost of compliance per target group considered by sponsor Receives compensation for administrative burden of data collection No Characteristics of post-implementation target feedback Incentive target given opportunity for full explanation of results before use Incentive target groups/individuals given comparative information Information provided on how results will be used Mechanism to consider additional information and communicate back to target Process available for target to provide additional information and/or corrections Blinding of performance feedback with targets Results disclosed with comparison to benchmarks Results to peers with names disclosed Full public reporting Frequency of performance feedback to the targets Quarterly Semi-annual Annually PROGRAM EVALUATION How the program evaluates its success Improvements in clinical performance Improvements in health status of population Other types of evaluation Specify Meet purchaser expectations, trend impact, provider satisfaction Evaluator Program sponsor Additional results of program evaluation Demonstrated Impact Nationwide HealthPartners groundbreaking work in composite measurement and quality innovation (Partners in Quality) is rapidly being adopted across the country: • The Institute of Medicine’s report Performance Measurement: Accelerating Improvement recognized HealthPartners for pioneering the concept of composite measurement and has recommended our composite measurement methodology be adopted across the country. HealthPartners was one of six case studies – and the only health plan- profiled in the report. • As a result of the Institute of Medicine’s report, the National Quality Forum and the Agency for Healthcare Research and Quality are both convening advisory panels on composite measures, which will have a lasting impact nationwide. Dr. Gail Amundson from HealthPartners has been invited to serve on both of these panels. • The Centers for Medicare and Medicaid Services has already added a composite measurement requirement, using HealthPartners methodology, to their 8th Scope of Work for Quality Improvement Organizations across the country. • The Institute for Healthcare Improvement has built HealthPartners composite measures into its 100,000 Lives Campaign, a broad national effort to achieve urgent health care reforms. Our measurement methodology provides the basis for each of the six measures: Prevent Respirator Pneumonia; Prevent IV-Catheter Infections; Stop Surgical-Site Infections; Respond Rapidly to Early Warning Signs; Make Heart-Attack Care Absolutely Reliable; and Stop Medication Errors. National Recognitions • In 2006, HealthPartners was the national benchmark for the eValue8 Provider Measurement module. • The National Business Group on Health awarded HealthPartners its prestigious 2006 Award for Excellence and Innovation in Value Purchasing for our innovative All-or-None composite measures and Pay for Performance programs. • In 2007, HealthPartners was selected by the National Quality Forum as the 14th recipient of the National Quality Healthcare Award. This award recognizes organizations for having a "proactive and exemplary response to the national call for quality improvement, for successfully using performance measurement to drive improvements in quality and efficiency, and for fostering a culture of transparency and accountability to patients and the community." Improved Performance and Patient Outcomes • Systematically improving cardiovascular (CV) risks for members with diabetes and CVD has helped reduce the number of deaths from heart disease by 4,000 across the state. • More than one in five members with diabetes meet all CV risk targets and over half meet all but one. • HealthPartners Optimal Diabetes Care rates are 38% higher than the Minnesota average of 16%. Nationally, this rate is not yet reported. • Members with diabetes, suffer 80 fewer heart attacks, 120 fewer amputations and 320 fewer eye complications each year compared to our 1994 baseline. • Since 2002, generic drug use increased from 45% to 58%, reducing drug costs by $62 million. • 92% of members are asked about tobacco use; 70% of smokers received help quitting. Tobacco use among fell to an all time low of 15%. Children’s exposure to second hand smoke fell from 23% to 8.6% exceeding the Healthy People 2010 goal of 9%. • A formal Harvard University evaluation found a 17:1 ROI in 2003 across CV disease and diabetes. Lessons learned from designing and implementing the program The primary goal of the Partners in Quality Program is to improve the health care quality, patient experience and safety. In order to meet this goal it is critical to have a robust quality improvement program that is seen as successful by the health plan involved as well as the participating providers. Following are some lessons learned from the development and implementation of our program: • Practicing physicians must participate in program design. Developing the program cooperatively with physician groups promotes success. • Performance measures must be evidence-based, clinically relevant and continually updated. • Performance measures must be valid, reliable, reproducible and transparent. • Focusing on the selection of measures for which a baseline exists prior to use in an incentive program is key to successful target setting and to medical group readiness to address the improvement efforts needed. • Targets must be tailored to the specific type of provider in the program. • The program must provide on-going support to providers to improve performance. • Program criteria and payment methodologies must be easily understood. • Rewarding on composite measures encourages improvement in both the quality of healthcare and the delivery of healthcare (process and outcomes. • Pay-for-performance alignment with health plan strategic plan and/or community focus accelerates improvement. • Constancy of focus increases program effectiveness and provider engagement. • To change performance across the network, performance goals must be ambitious (stretch goals) yet be realistic and achievable. • Rewards must be significant enough to motivate and recognize exceptional performance. • Public recognition (not just monetary) motivates providers and is appreciated. • The program can grow and change over time to become more robust by covering more types of providers, by using targets based on more current initiatives, or by increasing the amount of money involved. • The program must not be administratively burdensome for either the plan or the providers involved.

© 2006 Leapfrog and Med-Vantage. Assisted by Booz Allen Hamilton and Discern Consulting.
Technical and design assistance by Raven Creative, Inc.