HealthMart 2005 Conference - Session 1 Description
"Paying for Quality: Does it add up?"
Friday, September 30, 2005 - 8:00am-4:00pm
Marriott Hotel, Rt 128 & 3A (One Mall Road), Burlington, MA |
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Session 1 Description:
Panel Discussion on "Paying for Quality: Does it add up?"
Pay-for-Performance Measures Provide Untapped Data |
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In the course of processing claims and measuring quality, health plans collect information that could be used to improve patient care, according to Dale Magee, MD, Vice President of the Massachusetts Medical Society.
"Most physicians don't have the electronic medical record; yet a great deal of useful information resides in health plans," said Magee. "I'd like to see the plans develop a registry so that information can be put to work on behalf of patients, not just used to reward physicians after the fact."
Dr. Magee will take part in a panel discussion on "Paying for Quality: Does it Add Up?" at the Consortium's HealthMart 2005 conference. Joining him on the panel will be moderator Mansoor A. Khan, ScD, CEO of DiagnosisOne; Marylou Buyse, MD, President of the Massachusetts Association of Health Plans; and Alan Macdonald, Executive Director of the Massachusetts Business Roundtable.
"As physicians we're generally interested in quality and, from a policy perspective, see pay for performance as a means to close the quality gaps that plague the health care system," said Dr. Buyse.
Meeting quality standards requires time and effort by physicians, so they deserve a financial reward, she said. And to make clear what the standards are across various health plans, the Massachusetts Association of Health Plans has published a booklet of clinical standards, the Massachusetts
Physician Incentives Guide. It clarifies, for example, what the expectations are for hemoglobin A1c testing, which indicates a diabetes patients' control of blood sugar over time.
"Pay for performance offers more potential for cost savings in employer-employee health plans than changing insurers, changing coverage levels or changing plan administrators," said Macdonald. "Even more importantly, pay for performance allows an employer to promote consistently positive health care outcomes for its employees."
Dr. Magee said that physicians generally agree that measuring quality and rewarding those who are meeting standards is a good idea, yet there are concerns about how well the pay-for-performance system works. "Minor distinctions between groups can appear more significant under pay-for-performance," he said.
He also discussed management and information technology issues in the provider setting.
"Often physicians don't have the ability to call up reports in their offices," he said. But the problem goes beyond data to management skills in the office setting. "The physicians need to adjust their thinking so that they realize they must pay attention, not only to the patient appearing in front of them at the moment, but also to those who don't come in. They need to reach out."
Dr. Buyse noted that this sort of outreach is standard practice with dentists and veterinarians. "Not only is it good health care practice; it's also good business practice," she said.
Dr. Khan recalled a recent conference where he heard a physician saying that medical providers are trained to do the right thing and have chosen their professions to help others. The physician said that, therefore, fiddling with their pay by a percent or two either way is not as effective as getting them the information they need to avoid errors and improve care.
DiagnosisOne is striving to do just that. The firm has developed a system that takes hospital, lab, and pharmacy claims data, does "an almost real-time analysis," then applies evidence-based clinical standards to generate alerts.
"If alerts are generated, we contact the attending physician and provide feedback," he said. "We will then determine how useful providing that information is."
The panel discussion takes its name from the title of the HealthMart 2005 conference: "Paying for Quality: Does it add up?" which will be held Friday, Sept., 30, at the Marriott Hotel in Burlington.
For further information on any of our conferences and events, please contact Ellen Kreopolides, Event Planner, via e-mail or by phone (781)768-2519. If you would like information on exhibiting opportunities for this or other events, please contact Arleen Coletti, Director of Member & Exhibiting Services via e-mail or by phone (781)768-2512.
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