P4P drives quality for better business

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CHICAGO, Nov. 28—The time is now to take on an innovative business approach if radiology is going to balance cost and quality. That message was delivered yesterday in the Quality Improvement Symposium, “Leveraging Quality as a Strategic Advantage: The Business for Quality,” at the 93rd annual meeting of the Radiological Society of North America (RSNA).

Thomas H. Lee, CEO, Partners Community Healthcare and network president, Partners Health System, Boston, dove into the business side of healthcare insurance, coverage and affordability.

“In Massachusetts, we’re making a real effort to get everyone covered,” he said. Today, one-third of those who had no healthcare insurance a year ago now have coverage through Commonwealth Care. 

The greatest challenge is that health insurance premiums are running significantly higher than wage growth.

“The affordability crisis has center stage,” Lee said. “Healthcare affordability is no longer just a problem for the poor; middle class as well are having a problem paying the full load of the cost.”

What are the options to tackle this crisis? Lee suggests considering prior authorization, tiered networks, consumerism with cost shifting, capitation, and reduce fees to providers. “We have to come up with ways to make healthcare work among these options,” he said.

Cautiously he added another option – higher taxes, which he was quick to he his mother let her son know that was not a good idea. In 2006 many others agreed with his mother; only 39 percent of a surveyed group thought someone who earns more should pay more to cover the cost of people who are less well off.

“I tell my colleagues we are all smart enough to take responsibly for healthcare. There aren’t other options. We have to come up with some way among these options to make healthcare work financially,” said Lee.

At Partners Healthcare they opted to move to a P4P model. They worked with Blue Cross Blue Shield of Massachusetts to establish the P4P incentives based on long-term vision.

MDs who achieve targets are rewarded with a greater net increase, while MDs who do not will receive their guaranteed increase, but will see a lower net. Some of the targets include increased efficiency, reduced hospitalizations, and electronic medical records (EMR).

The P4P contract has prompted an increase in EMR adoptions among the participating physicians. EMR adoption has grown to 90 percent from 9 percent in 2003. By the end of next year all will be online, or they will be out of the program.

“We’re taking healthcare in a better direction with new measures,” said Lee.

New major target areas have been added in he said. “We’re trying to bring off two revolutions: an industrial revolution where clinicians use systems to reduce errors; and a cultural revolution where there is teamwork instead of doctors as lone cowboys.” It’s a re-engineering of care in process.