Transcript Context and rationale for Pay for Performance in SUD

Context and Rationale for Pay
for Performance in SUD
Treatment
NIATx-SI State Call
April 2010
Core Foundation
Health Care Arena – Addiction is a
HEALTH problem:
Part of mainstream healthcare
Not fundamentally criminal justice
Chronic not acute condition:
Purchasers will need to change contracts, funding
mechanisms and expectations
Treatment programs will need to change from acute to
chronic care design and service delivery
(more)
Core Foundation
Recovery is the goal
Treatment prepares for recovery
Continuing care
Disease management
Recovery Support
Recovery Coaches/Linkage Coordinators
Family and other “community strengths” support
Return to treatment program for “tune ups”, etc.
Medication Assisted Treatment (MAT)
New medications for addiction
Psychotropic meds for co-occurring MH disorders
Acute Care Assumptions
Some fixed amount or duration of treatment will
resolve the problem
Treatment Completion is a goal and expected
outcome
Evaluation of effectiveness should occur following
completion
Poor outcome means failure
In Chronic Care
The effects of treatment do not last very
long after care stops
Patients who are out of treatment/contact
are at elevated risk for relapse
New Expectations
Programs are responsible for results
during treatment.
Treatment offers choices – adaptive care.
Evaluation is a clinical activity and every
patient is evaluated.
Implications
Let go of traditional beliefs and practices
that are not grounded in science/research
or proven practice
Easy transition between levels of care and
treatment programs
Collaboration vs. competition among
programs
Continuing care and telephone based
counseling (texting?)
Some System and Program
Changes
New funding models to purchase care
System integration not autonomous
programs
Bundling services
Collaboration across treatment agencies
Connecting payment to performance:
Reward Quality not Quantity
Performance based contracting
Incentives for results
Congressional Research Service
Report for Congress
P4P Defined
A pay for performance system is a remuneration
arrangement in which a portion of the payments
is based on performance assessed against a
defined measure.
Typically, there is another component of the
remuneration that is independent of the amount
at risk.
The terms merit and bonus pay are also used to
describe similar systems.
Theory and Conceptual
Foundation
Elements common to P4P programs
A set of targets or objectives that define what will
be evaluated
Measures and performance standards for
establishing the target criteria
Rewards – typically financial incentives – that are
at risk, including the amount and the method for
allocating payments among those who meet or
exceed the reward threshold.
CEO Survival Guide: Pay for
Performance – 2006 Edition
National Committee for Quality Health Care
1701 K Street, NW Suite 205
Washington, DC 20006
www.ncqhc.org
Impact of Private Sector P4P
Programs (35-36)
Rewarding Results grant program funded
by RWJF and California Healthcare
Foundation, and administered by the
Leapfrog Group
Impact of Private Sector P4P
Programs (35-36)
Financial incentives motivate change – provided
they are large enough to make a difference.
Non-financial incentives also can make a
difference.
Engaging physicians is a critical activity – they
must be brought in early as collaborators to
ensure that the goals are clinically meaningful.
There is no clear picture yet of return on
investment.
Impact of Private Sector P4P
Programs (35-36)
Public reporting is a strong catalyst for
providers to improve care.
Providers need feedback on their
performance.
Providers need to be better educated
about P4P.
Data integrity is important.
(more)
Impact of Private Sector P4P
Programs (35-36)
P4P is not a magic bullet – it is one of a
number of activities that can work to
improve healthcare quality and change the
way it is delivered and financed.
MedVantage P4P Survey
2008
N = 62 P4P Program Responses
What Results do you attribute to P4P?
84% - Performance on clinical measures improved
66% - Improvement was statistically significant
What changes do you anticipate making?
65% - Expand scope or number of measures used
53% - Change performance domains or relative
weighting of measures
0% - Discontinue the program
Connecting Payment and
Performance in SA Disorder
Treatment
Personal Purchasing
What do you do when buying a new:
Car, Computer, Appliances, etc.
Compare models, features, price
Consider quality, performance and
reliability
State As Purchaser
State sets the expectations:
Based on science/research/proven practice
Defines the expectations and results
Who can best provide what I want?
Contracts and pays for performance and
results.
SA treatment provider = seller – how can
they convince state to buy what they are
selling?
Overall Context for P4P
Need for new financing and funding
models for healthcare and SA treatment:
Fee for service, grant and contract funding
do not reward performance and results
Bundled care, networks and collaboratives
Incentives for results
P4P is not a stand-alone solution for
performance improvement or achieving
better results
Government precedents
Paying For Performance
Connecting payment to performance and
results at a program or network level
Not to individual practitioners
Not to patients, clients – not contingency
management/motivational enhancement
Connecting payment to a few very specific
targets that will improve service delivery
and/or results:
Examples - access, retention, continuing
care
Chronic/Adaptive Care
Chronic not acute care treatment design
– System wide
– Individual treatment programs
Disease management not program approach
– Continuing care
– Recovery support
– Self management
Think/fund system of care not individual
programs
P4P Design Implications
Design system to require collaboration
among providers, including continuity of
care/maintenance
Include rewards for collaboration – decide
where to place the incentives (push-pull)
Examples
Pay a % of base contract for providing
agreed upon/contracted services
– Pay remainder for achieving critical
performance targets
Pay incentives for meeting agreed upon
performance targets.
Contact Information
Jack Kemp
[email protected]