Perhaps health plans should collaborate on P4P

Health plans acting individually will have a difficult time maximizing physician participation in pay-for-performance (P4P) programs, so they need to collaborate with their competitors, according to recent findings from Bridges to Excellence (BTE), a not-for-profit organization that promotes quality improvement by designing and implementing programs that recognize and reward high-performing physicians.

“If you’re trying to improve the care of the majority of your plan members, you’re going to be able reach about 20 percent of the physicians in your network, but you’re not going to effectively change the behavior of the other 80 percent,” says Francois de Brantes, chief executive officer of Bridges to Excellence.

Uneven distribution of patients and reward potential for doctors

A BTE study published in the American Journal of Managed Care assessed the response rates of physicians to BTE rewards. When a physician is recognized by BTE for providing quality care, it costs the health plan about $250 per patient. The researchers plotted the distribution of patients and reward dollars per physician. Most of the physicians had very few patients who were eligible for the program and, therefore, had a very limited potential for rewards.

The researchers suggest that by “aligning their P4P efforts, health plans may, in effect, alter the distribution of reward potential so that more physicians have high reward potentials, which will increase their likely rate of participation. A health plan’s self-interest might be best served by collaborating with others around aligned incentive programs if the sum of the incentives collaboratively offered increases the overall participation rate of physicians.”

De Brantes points out that there are no legal considerations because “plans are allowed to collaborate on programs designed to improve the quality of care. A good example is the statewide P4P effort in California in which all plans participate.”

“If all the plans want to impact the majority of physicians in the network, they need to send a common signal to that network,” says de Brantes. “You need to identify a common core set of performance measures that everyone is going to focus on.”

Source: de Brantes F, et al. Physicians respond to pay-for-performance incentives: larger incentives yield greater participation. 2009; Am J Manag Care; 15:305–310