Section Sponsored by:

What dollar figure would you put on quality care?

That's the heat of the debate about tying compensation to provider performance. Detractors say quality in health care is hard to measure and even harder to define. In addition, one person's definition of quality of care may not necessarily correlate to better outcomes, which often fall outside the physician's control.

Still, in an effort to control skyrocketing healthcare costs, the government and almost all payers are moving forward to feverishly implement programs that pay more for documented quality of care. Are you ready to meet these metrics?

Interestingly, studies indicate these economic incentives do change physicians' behaviors, as well. One study shows primary care physicians paid exclusively via fee-for-service (FFS) arrangements are more likely to provide HMO services that come with additional compensation-when compared to a capitated model.¹ Hybrid models currently mix capitation with fee for service, giving incentives that drives physicians to perform more preventive and timely services. The hope is these measures will reduce more expensive interventions at later stages.

For these models to succeed, however, providers must have the tools necessary to make informed evidence-based decisions at the point of care.  In addition, doctors will also need to keep track of the patient outside of the hospital encounter. Access to population health management tools will allow doctors to reach out to their patients both during the encounter and after.

Make Healthcare Data Actionable
While electronic health record (EHR) systems do a great deal to manage clinical data, they do not contain the clinical intelligence and knowledge needed to effectively make the data actionable. To accomplish this goal, providers must acquire effective real-time clinical decision support (CDS) and population management (PM) tools.

An integrated CDS and PM system allows healthcare providers to choose which clinical profiles they wish to actively manage and then ensure the providers receive alerts and notifications containing actionable information at, or near, the point of care. Simultaneously, the provider can also define custom patient populations to reach out to patients with specific care recommendations.

An effective system must have flexibility for the provider to target specific populations and choose the rules and alerts they wish to receive. A provider group may select rules covering major chronic conditions, for example. Thus, they could define (and if necessary create) a custom set of rules allowing them to manage a patient suffering from diabetes and cardiac disease.  The system would prompt the provider to select order sets, educate the patient and provide brochures. The provider would also receive real-time alerts to ensure that the patient is tested regularly.  For instance, the doctor would be reminded to perform LDL testing on a cardiac patient.

The integrated PM system would then provide dashboards for monitoring the patient populations for conditions, along with the ability to drill down to the patient level. For example maintaining the LDL level below 100 mg/dL could result in incentive payments. Once the system has identified the patient population, the PM system could generate specific patient letters and e-mails, requesting patients to take specific actions based on their condition.

A changing payment structure Performance-based incentive plans are becoming a more common part of a physician's compensation package. These usually are offered on top of a base salary. Here is the percentage of physician practices that offered annual incentive plans, by practice structure. This data is sourced from- http://www.ama-assn.org/amednews/2010/10/04/bise1004.htm

Small provider groups can band together and form organizations that could then pool their resources to acquire the appropriate technologies. However, private practices must also be cautious since these groups can run the risk of running afoul of the regulations regarding anti-competitive activities.

Fortunately, the Federal Trade Commission has been relaxing the rules governing anti-competitive practices, as long as providers that wish to join together can demonstrate that the purpose of the union is to improve care. Providers who deploy the sophisticated CDS and PM tools should be able to demonstrate the organization's primary goal is to improve care rather than to fix prices.

Measure of Quality
Over the next few years, more of a provider's compensation will be tied to some measure of the quality of care provided. This trend has the potential to adversely affect the smallest provider groups most. However, technologies are now available to turn this trend into a positive for all providers. The key factor is joining together and deploying the appropriate CDS and PM technologies.

These technologies will enable stakeholders to benchmark, measure and trend quality metrics and even outcomes to an extent. Tying these metrics and outcomes to reimbursements is a small step forward in an imperfect world of soaring medical costs.

Mansoor Khan is chief executive officer at Diagnosis ONE.