At Harvard Pilgrim, it’s our goal to continually bring innovations to our provider network that can improve the quality and efficiency of health care. One approach you may have heard of is Pay for Performance.
Pay for Performance (P4P) is a payment model that compensates doctors and hospitals when certain goals and benchmarks are met. Metrics include administrative efficiency, cost effectiveness and the quality of medical care.
However, not all P4P plans are created equal. Harvard Pilgrim created a portfolio of P4P incentive programs for 2011 that focuses on the measurement of quality, efficiency and outcomes in the care provided to Harvard Pilgrim members.
The 2011 standard incentive program is called Quality Advance. Most program elements incorporate quality measures, which vary depending upon whether practice groups are comprised of adult practitioners, pediatric practitioners or both. The following categories are examples from the full measurement menu in the Quality Advance Program:
- Prescribing patterns that reflect optimal use of lower-cost Tier 1 drugs
- Lab/Path Steerage that rewards performance in directing clinical laboratory and pathology services to cost-effective, preferred providers (as approved by the health plan)
- Patient-Centered Care Coordination that includes advanced directives, physician-to-physician communication standards and patient engagement
- Hospital utilization and weighted admissions per thousand that address the use of community settings and unnecessary inpatient admission that are best managed in an effective ambulatory setting
- Assessment of the level of Health Information Technology dispersal and functionality across large groups of practices
P4P is just one of the ways we’re working with the provider community to support our members and make health care work better. Find out more at harvardpilgrim.org.