WASHINGTON – California health plans paid $65 million in 2007 to California physician groups participating in their pay-for-performance programs, the Integrated Healthcare Association has reported.
As more payers across the country implement or report results of P4P programs, the question of whether the industry needs national standards for measuring quality is being asked.
“I think we need national standards,” said Thomas Williams, IHA’s executive director.
National quality standards can be used by all P4P programs as the core set for measurement, with states, payers and healthcare organizations adding new measures to address their particular patient population, he said.
The National Quality Forum has endorsed 350 performance measures of leading clinical conditions that comprise the bulk of healthcare services, said Janet Corrigan, president and CEO.
Despite the number of measures, she said there is an imbalance of process over outcomes measures due to P4P programs’ reliance on claims data. She believes electronic health record systems with connectivity to capture relevant data and embedded quality measures within the care process will have a more immediate impact on healthcare.
NQF’s role is to develop and validate best-in-class performance measures for communities to implement. National standards are important for nationwide comparisons. “There are significant differences in how healthcare is delivered in communities,” Corrigan said. “We can learn from each other and not reinvent the wheel.”
More than 100 quality measures for ambulatory care have been validated by Bridges to Excellence, said CEO Francois de Brantes. He said the problem is that “the performance and quality measures that truly matter aren’t being used as consistently and strongly as they should.”
De Brantes said IHA is a great example of a successful P4P program because of its neutral convener model, multi-payer collaboration on a consistent, common set of measures and data aggregation and the pooling of significant funds to incentivize physicians.
Standards for quality measurements are there, he said. It’s a matter of whether organizations use them.