4_03ppt - PowerPoint Presentation.ppt

click to edit footer Aligning Hospital and Physician P4P – The Q-HIPSM/QP-3SM Model Rome H. Walker MD February 28, 2008 A Concerted Effort Anthem’s Quality Evolution Q-HIPSM - Aligning with National Performance Based Incentive Principles Q-HIPSM : Is voluntary Consistently applies nationally vetted and recognized evidence based indicators Aligns reimbursement with the practice of high quality and safe health care for all consumers Is transparent with external validation and auditing of data Based on all-payer data The Q-HIPSM Patient Safety Organization (PSO) Q-HIPSM – A Collaborative Effort Quality-In-Sights? Hospital Incentive Goal  ACC-NCDR STS National Database Scorecard Components Q-HIPSM Hospitals in Virginia Q-HIPSM in Virginia 65 hospitals participating in Q-HIPSM in Virginia 95% of Anthem inpatient admissions in the Commonwealth of Virginia Rural, local and tertiary care hospitals Measurement period runs July-June; started in 2003 Outside Virginia: Northeast Region (ME, NH, CT): 32 hospitals Georgia: 21 hospitals New York: Pilot/Rollout Phase California: Pilot/Rollout Phase Q-HIPSM Model Adoption in WellPoint States Encouraging Developments Q-HIPSM – Why it Works No “Black Box” – measurement methodology, metric specifications all transparent to participants Third party administrator – unbiased evaluation by the PSO Collaboration is critical (success is directly proportional to involvement of key personnel) Financial incentives can lead to a higher organizational prioritization Alignment of physician and hospital goals focuses efforts Adoption of national quality metrics Q-P3SM Program Q-P3SM is Anthem’s performance based incentive program (Pay-for-Performance) for physicians Opportunity to reward high quality performance Collaborated with the American College of Cardiology and the Society of Thoracic Surgeons Researched published guidelines, medical society recommendations and evidence-based clinical indicators Programs impleme