Docstoc

Preconception Care Policy Issues

Document Sample
Preconception Care Policy Issues Powered By Docstoc
					Preconception Health
Policy and Finance

Anne Rossier Markus, JD, PhD, MHS
Associate Research Professor, Department of Health Policy
The George Washington University


2007 CityMatCH Urban MCH Leadership Conference
August 26-28, 2007
Denver, Colorado
Outline - Access to Quality
Preconception Care
                      CDC Recommendation:
    To Improve Health Insurance Coverage of Preconception Care

          especially for low-income women who may be at
                 higher risk for adverse birth outcomes

   CDC Select Panel’s Workgroup on Financing of
    Preconception Care

   CDC Action Steps
     – Improving the Design of Medicaid Family Planning
       Waivers
     – Monitoring, and Tying Payment to, Quality of
       Preconception Care through the HEDIS Measurement
       System
CDC Select Panel’s Workgroup on
Financing of Preconception Care:

Findings and Recommendations

March 9, 2007
Workgroup Membership
   Co-Chairs:
    – GWU SPHHS Department of Health Policy
    – Dartmouth-Hitchcock Medical Center Department of Pediatrics
    – CDC Workgroup Lead

   Members:
    –   JIWH; KFF
    –   AGI; ACOG; MOD
    –   NACCHO
    –   ASTHO; NCSL
    –   AMCHP; NACHC; National Healthy Start Association
    –   CDC; HRSA-MCHB; CMS
Working Parameters
1. Vision for Preconception Care
2. Definition of Preconception Care
3. Standard of Preconception Care

BUT

4. Mixed private and public financing
system with lack of universal coverage of
women of reproductive age
1. Vision for Preconception
Care
   All women of childbearing age have
    health coverage
   All women of childbearing age are
    screened prior to pregnancy for risks
    related to outcomes
   Women with a prior adverse
    pregnancy outcome have access to
    intensive preconception care to reduce
    their risks
2. Definition of
Preconception Care
 A set of interventions that aim to
 identify and modify biomedical,
 behavioral, and social risks to a
 woman’s health or pregnancy outcome
 through prevention and management,
 emphasizing those factors which must
 be acted on before conception or early
 in pregnancy to have maximal impact.
3. Standard of Preconception
Care & Core Components
       Assessment &                                     Health Promotion
         Screening                                        & Counseling
 Medical & reproductive history;                     Healthy weight; Nutrition;
     Genetic & family history;                         Preventing STD & HIV
  Environmental & occupational                       infection; Family planning
 exposures; Family planning and                      methods; Abstaining from
pregnancy spacing; Nutrition, folic                 tobacco, alcohol, and illicit
      acid intake, and weight                       drug use before and during
    management; Medications;                        pregnancy; Consuming folic
 Substance use (alcohol, tobacco                   acid; Controlling pre-existing
    and illicit drugs); Infectious                    medical conditions (e.g.,
   diseases; Psycho-social (e.g.,                       diabetes); Risks from
  depression, domestic violence,                    prescription drugs; Genetic
                housing)                                     conditions
                                     Brief
                                 Interventions
                                      Immunization
                                    Smoking cessation
                                     Alcohol misuse
                                   Weight management
                                     Family planning
                                        Folic acid

 Source: Kay Johnson, March 2007
4. Mixed Financing & Lack of
Universal Coverage of Women
of Reproductive Age




Sources: US Current Population Survey, AGI, KFF.
March 9 Meeting Objectives
   Discuss and reach consensus on key attributes of a high
    performing system of preconception care financing
    (public and private)

   Discuss options for Medicaid coverage

   Discuss the roles of public health programs (i.e., Health
    Centers, Title X Family Planning, Title V MCH Block
    Grant, Healthy Start)

   Discuss next steps
Key Attributes of a High
Performing System of
Preconception Care Financing
   Eligibility
   Enrollment and Transition between Financing
    Arrangements
   Benefits and Coverage Rules
   Cost-Sharing
   Access to Community Providers
   Privacy, Confidentiality and Access to Health
    Information
   Quality and Provider Compensation
    Eligibility (consensus)
   Cover all women during their reproductive life span
    (from menarche to menopause)

   Cannot set arbitrary limits based on age

   Cannot impose coverage limits or waiting periods based
    on pre-existing conditions

   Cannot use an asset test

   Must provide subsidies for women whose family incomes
    are considered low (e.g., < 200% FPL)
    Enrollment & Transition
   Public financing:
    – Enrollment at the point of care, through outstationing,
      and in other locations convenient to consumers
    – Continuous enrollment until circumstances change,
      requiring review (e.g., change in income)
    – Loss of private coverage should be an immediate
      qualifying event for public coverage


   Private financing:
    – Portability of coverage
Benefits & Coverage Rules
   Equivalent to the existing standard of preconception care
    – Screening/assessment
    – Counseling/health education and promotion
    – Interventions/treatment

   No arbitrary limits or exclusions

   Provided by any licensed HCW within scope of practice

   Medical necessity standard promotes (i) attainment and
    maintenance of optimal health in reproductive years and
    (ii) correction and amelioration of physical or mental
    conditions that could adversely affect reproductive health
    Cost-Sharing

   No deductibles for services identified as
    primary preventive care

   Use of co-payments and/or coinsurance only
    if affordable

   Availability of direct subsidies for community-
    based providers that serve low-income
    women to help offset the cost of cost-sharing
    and to furnish enabling services
Access to Community
Providers
   Provider network in the community should be
    adequate to furnish covered services

   Participation of community health providers
    should be allowed
Privacy, Confidentiality and
Access to Health Information
    Patients and health care providers should
     have full and ready access to health
     information necessary for treatment and
     payment, in a secure and interoperable
     environment

    Systems should exchange essential
     information to measure population health
     with public health agencies
Quality & Provider
Compensation
   Appropriate compensation for providers up to
    their scope of practice

   Compensation guided by principles of quality
    performance, with regular and systematic
    measurement of process and outcome of care
    – Existing measures (e.g., HEDIS postpartum care)
    – New measures (e.g., reproductive health plan,
      minimum number of visits, screening tools)
Options for Medicaid Coverage
Federal and State Levels

   ―Women‖ as a new optional eligibility category

   State’s choice to (i) cover some or all women
    not currently covered and (ii) determine scope
    of benefits essential to wellness – e.g.,
        Full Medicaid benefits
        Preventive preconception package

        Family planning
Roles of Public Health Programs
Public Health Programs
   Title X FP programs serve ~4.6 million
    women of childbearing age (FP education;
    contraceptives; pregnancy tests)
   Title V MCH services block grant programs
    serve ~2.5 million pregnant women
    (prenatal, delivery, and postpartum care
    for low income, at-risk pregnant women)
   Health centers serve ~4.5 million women
    of childbearing age and provide prenatal
    care to some 330,000 pregnant women
Other Programs (Cont.)

   HRSA’s Healthy Start program serves
    high-risk pregnant women in 99
    communities in 38 States, the District of
    Columbia, and Puerto Rico
    (interconception activities)

   WIC serves ~8 million women during
    pregnancy and postpartum (nutrition
    screening and counseling; supplemental
    food; referrals to health services)
Federal and State Levels

   Programs need augmented federal appropriation

   Within existing funds, opportunities to embed
    preconception care into existing services

   Need to monitor and disseminate promising
    practices at the state and local level
Next Steps
Products and Activities
   Revise and distribute principles for financing
    preconception care

   Develop prototype fact sheets for federal and state
    advocates

   Prepare an update on preconception benefits within
    Medicaid family planning waivers

   Publish a special issue of Women’s Health Issues

   Work with selected state/local leaders on advocacy
Improving the Design of Medicaid
Family Planning Waivers
 US Women of Child-Bearing Age,
 2006
    According to the US Census Bureau, there
     are nearly 62 million women age 15-44
    34% are low-income (<200% of poverty)




Source: http://www.census.gov/hhes/www/cpstc/cps_table_creator.html
Insurance Coverage of US Women
of Child-Bearing Age, 2003




Sources: US Current Population Survey, AGI, KFF.
Uninsured Women by Age, 2004




                     Total: 19.5 million

Source: Salganicoff, A., Ranji, U., and Wyn, R. Women and Health Care: A National
Profile, Kaiser Family Foundation, Washington, DC, July 2005
  Uninsured Women of Childbearing
  Age (15-44) by Educational
  Attainment, 2006




               Total: 12.4 million
Source: US Census Bureau, Current Population Survey, Annual Social and Economic
Supplement, 2006 http://www.census.gov/hhes/www/cpstc/cps_table_creator.html
Uninsured Women of Childbearing
Age (15-44) by Parental Status,
2006




                            Total: 12.4 million
Parent is defined as having 1 or more related children under age 18

Source: US Census Bureau, Current Population Survey, Annual Social and Economic
Supplement, 2006 http://www.census.gov/hhes/www/cpstc/cps_table_creator.html
Uninsured Women of Childbearing
Age (15-44) by Income, 2006




                 Total: 12.4 million

Source: US Census Bureau, Current Population Survey, Annual Social and Economic
Supplement, 2006
http://www.census.gov/hhes/www/cpstc/cps_table_creator.html
Uninsured Women of Childbearing
Age (15-44) by Employment, 2006




              Total: 12.4 million
Source: US Census Bureau, Current Population Survey, Annual Social and Economic
Supplement, 2006
http://www.census.gov/hhes/www/cpstc/cps_table_creator.html
    Girls, Adolescent Girls, and
    Women’s Eligibility for Medicaid
    Mandatory Populations                   Optional Populations

    Children below federal                Children above federal
     minimum income levels                  minimum income levels
      –   Ages 1-6: 133% FPL
      –   Ages 6-19: 100% FPL              Children ages 19-21

    Adults in families with children      Adults in families with children
     (Section 1931 and TMA)                 (above Section 1931
                                            minimums)
    Pregnant women <133% FPL
                                           Pregnant women >133% FPL
    Disabled SSI beneficiaries
                                           Disabled (above SSI levels)

                                           Disabled (under HCBS waiver)

                                           Medically needy
 Income Eligibility Levels for
 Medicaid for Pregnant Women,
 2006




Source: Kaiser Family Foundation, 2006 http:www.statehealthfacts.org
Income Eligibility Levels for
Medicaid for Women as Parents,
2006




Source: Kaiser Family Foundation, 2006 http:www.statehealthfacts.org
Medicaid Defined Benefits
“Mandatory” Items and Services            “Optional” Items and Services


    Physicians services                 Prescription drugs
    Laboratory and x-ray services       Medical/remedial care furnished by licensed practitioners
    Inpatient hospital services         Diagnostic, screening, preventive, and rehab services
    Outpatient hospital services        Clinic services
    Early and periodic screening,       Dental services, dentures
     diagnostic, and treatment           Physical therapy
     (EPSDT) services for                Prosthetic devices, eyeglasses
     individuals under 21                TB-related services
    Family planning and supplies        Primary care case management
    Federally-qualified health          ICF/MR services
     center (FQHC) services
                                         Inpatient/nursing facility services for individuals 65 and
    Rural health clinic services         over in an institution for mental diseases (IMD)
    Nurse midwife services              Inpatient psychiatric hospital services for individuals
    Certified nurse practitioner         under age 21
     services                            Home health care services
    Nursing facility (NF) services      Respiratory care services for ventilator-dependent
     for individuals 21 or over           individuals
                                         Personal care services
    Source: KFF, 2005.                   Private duty nursing services
                                         Hospice services
Purposes of Family Planning

   Provide individuals with personal
    choice in determining the number and
    spacing of their children and in
    preventing unintended pregnancies

   Ensure individuals’ reproductive health
    and well-being (through, e.g.,
    prevention of STDs and HIV, routine
    cancer screenings)
Unintended pregnancy in the
US
   Unintended pregnancy includes
    ―Mistimed‖ (wanted to become pregnant
    in the future, but not yet) and
    ―Unwanted‖ (did not want to become
    pregnant now or in the future)

   Associated with delayed PNC and
    substance abuse during pregnancy, which
    may lead to adverse birth outcomes
Unintended pregnancy in the
US (Cont.)
   Of the 6.4 million pregnancies in US in
    2001, 49% were unintended; of the 4
    million births, 1.4 million were from an
    unintended pregnancy
    40% of women who had an unplanned birth
     had used contraception during the month of
     conception
   More prevalent in poor and low-income
    women
Rates of Unintended Pregnancy,
by Race/Ethnicity and Income,
2001
  Unintended Pregnancies per
  1,000 Women




Source: Finer & Henshaw, 2006 Perspectives on Sexual and Reproductive Health, 38(2)
Basics of Medicaid FP Waiver
Programs
   Under Section 1115 of SSA
   Allows states to expand eligibility to women
    who otherwise do not qualify for Medicaid
    specifically for Medicaid FP services
    – Can be based on loss of eligibility of women
      postpartum or for any reason (e.g., starting a
      job)
    – Ineligibility due to income levels
   First waiver approved by HHS in 1993 (SC)
 26 States Have Medicaid Family
 Planning Waivers
    5 states—for women who have lost Medicaid
     eligibility postpartum

    2 states—for women who have lost Medicaid
     eligibility for any reason

    19 states—based on income; ~200% FPL


  (2001: ~ 1.7 million clients served in 13 states)
Source: Guttmacher Institute, 2007 SPIB: State Medicaid Family Planning Eligibility
Expansions; Gold, 2003 “Medicaid Family Planning Extensions Hit Stride”
 Services Provided Through
 Medicaid Family Planning Waiver
 Programs
    Coverage of FP services and supplies
     available to Medicaid enrollees in the
     state
    No cost-sharing
    FP services and supplies reimbursed
     90% by federal government; other
     services (e.g. STD testing) reimbursed
     at usual matching rate for the state
Source: Frost et al., 2006 “Estimating the impact of expanding Medicaid eligibility for
family planning services”
Evidence of Impact of FP Waivers
on Program Costs and Unintended
Pregnancies
   Budget neutral but not always reduction in number of
    unintended pregnancies (Edwards, Bronstein &
    Adams, 2003)
   CA program prevented 108,000 unintended
    pregnancies in 1997-98 (Foster et al., 2004)
   Simulation of income-based expansions to 200% and
    250% of FPL found it would be cost-effective if
    implemented nationally (Frost, Sonfield and Gold,
    2006)
   Income-based expansions are effective at reducing
    births; save money or are at least budget neutral for
    states; and are at least budget neutral nationally
    (Lindrooth and McClullough, 2007)
Strengthening the Design of Family
Planning Waivers in Relation to
Preconception Care
    A. Coverage & Payment of
    Quality FP and Preconception
    Care
    What are the guidelines for a quality FP and
     preconception care benefit (e.g., CMS, CDC,
     ACOG/AAP)?

    What are the services covered and paid by States
     (e.g., survey of preconception benefits and CPT
     codes recognized by states for reimbursement within
     FP waivers)?


    To what extent does state coverage and payment
     reflect the standard of care and are there
     opportunities for a core benefit to increase ability to
     ensure quality?
Federal Guidelines for FP Benefit-
Exist but Could be More Specific
to Preconception Care


                                                                  CDC Recommendations:
                                                                  Medical & reproductive
                                                                 history; Genetic & family
                                                                 history; Environmental &
                                                                 occupational exposures;
                                                                    Family planning and
                                                                     pregnancy spacing;
                                                                 Psycho-social assessment




Image reproduced from KFF, 2005 “Medicaid: A Critical Source of Support for Family
Planning in the US”
Examples of CPT Codes

   99384/94 (12-17 yrs); 385/95 (18-39 yrs);
    386/96 (40-64 yrs) -Preventive (no
    symptoms), new/established patient
   99420: Health risk assessment instrument
    for MH/SA services
   99501-Home visit for postnatal assessment
    and follow-up care
   96152- Health and behavior intervention
B. Coordination of FP
with Health Centers
   2001 requirement for states with FP waivers to set up
    formal arrangements with CHCs to provide primary
    care services to enrollees in the FP programs

   Enrollees must also be informed of how to access
    primary care services at CHCs

   Arrangements could be used to increase link between
    family planning and preconception services
    – Is coordination happening?
    – What services are provided?
    – How about primary care providers other than health
      centers?
C. Seamless Coverage
with SCHIP
   In FY06, 671,000 adults (parents, pregnant women,
    and childless adults) were covered through SCHIP

   In 2004, 17% (~3.3 million) of uninsured women were
    ages 18-24, some of whom may be ―aging out‖ of
    SCHIP (>19) or Medicaid (>21)

   SCHIP reauthorization
    – What will become possible with the reauthorization statute?
    – Medicaid expansion for children (e.g., 300% FPL) coordinated
      with a new SCHIP option to cover young adults?
Monitoring, and Tying Payment
to, Quality of Preconception Care
through the HEDIS Measurement
System
CDC Recommendation
   Maximize public health surveillance and
    related research mechanisms to monitor
    preconception health. Examples:
    – National PRAMS, BRFSS, NSFG
    – State and local PRAMS, Perinatal Periods of Risk,
      Fetal-Infant Mortality Review, YRBS
    – Title V performance indicators
    – KFF survey

   Maximize quality assurance mechanisms to
    monitor and improve preconception health
    – HEDIS
 Receipt of Family Planning and
 Reproductive Health Services
 Among US Women Ages 15-44
    According to the
     2002 NSFG, the
     majority of US
     women ages 15-44
     (72.7%) received at
     least one family
     planning or medical
     service in the past
     year

Source: Chandra et al., 2005 2002 National Survey of Family Growth
 Receipt and Provider of Family
 Planning and Reproductive Health
 Services Vary by Poverty Level




Source: Chandra et al., 2005 2002 National Survey of Family Growth
Survey of MCH programs
 Content of Health Care
 Among US Women, 2004

    Discussed with provider in the past 3
     years:
      31%        had    discussed         their sexual history
      28%        had    discussed         STDs
      31%        had    discussed         HIV/AIDS
      14%        had    discussed         EC



Source: Kaiser Family Foundation, 2005 Women and Health Care: A National Profile
HEDIS Measurement
System
   ―The Healthcare Effectiveness Data and
    Information Set (HEDIS) is a tool used by more
    than 90 percent of America's health plans to
    measure performance on important dimensions
    of care and service‖
    – 3 main areas: Access/Availability of Care,
      Effectiveness of Care, Use of Services
   Voluntary reporting to NCQA by commercial,
    Medicaid and Medicare plans (> 73% of all
    HMOs/POS plans, and 80 PPOs), which serve
    80 million Americans, with national benchmark
Source: http://web.ncqa.org/tabid/59/Default.aspx
Measures Reflect Evidence-
and/or Consensus-Based
Clinical Practice
   ACOG Guidelines
    – To give practitioners the chance to offer advice and
      assistance, women should see their health care
      provider at least once between four and six weeks
      after giving birth. The first postpartum visit should
      include a physical examination and an opportunity
      for the health care practitioner to answer parents'
      questions and give family planning guidance and
      counseling on nutrition.

   Guidelines for Perinatal Care – AAP & ACOG
    – All health encounters during reproductive years
      should include counseling on appropriate medical
      care and behavior to optimize pregnancy outcomes.
CDC Recommendations
   Specifically focused on pre-and inter-
    conception care

   Essential part of primary and preventive
    care

   Not just a single visit/multiple visits, but the
    process of care and interventions, which can
    include a pre-pregnancy visit, multiple
    postpartum visits, PNC, and an array of
    other services and procedures (i.e.,
    assessment, counseling, brief treatment)
 Measures Link to Health
 Risk Factors, Women, Ages
 18-44, 2002
    6% had asthma
    50% were overweight/obese
    3% had cardiac disease
    3% were hypertensive
    9% had diabetes
    1% suffered from thyroid disorder
    >80% (ages 20-39) had dental carries and
     other oral diseases
Source: CDC, 2006.
Measures Link to Behavioral
Risk Factors, Women, Ages
18-44, 2003 & 2005
   21.7% smoked (2005) and 11% of pregnant
    women smoked (2003)
   11% reported binge drinking in the last
    month (2005) and 10% of pregnant women
    drank alcohol (2003)
   84% reported hearing of folic acid (of those
    aware of folic acid, 19% knew it prevents
    birth defects, 7% knew it should be taken
    before pregnancy); 33% took a daily
    multivitamin with folic acid (2005)
   49% have unplanned pregnancies (2005)
Source: March of Dimes, www.marchofdimes.com/peristats, 2005; CDC, 2003
COLORADO PCPP, Percentage of
Women Receiving Appropriate
Care, 2004-2005




Source: HSAG, 2004-2005 External Quality Review Technical Report for Colorado
Medicaid Managed Care, Colorado Department of Health Care Policy and Financing
COLORADO Perinatal Focused
Study, Percentage of Women
Receiving Appropriate Care, 2004




Source: HSAG, 2004-2005 External Quality Review Technical Report for Colorado
Medicaid Managed Care, Colorado Department of Health Care Policy and Financing
NEW YORK QARR, Percentage of
Women Receiving Appropriate
Care, 2004




Source: HSAG, 2004-2005 External Quality Review Technical Report for Colorado
Medicaid Managed Care, Colorado Department of Health Care Policy and Financing
NEW YORK QARR, Percentage of
Medicaid Women Receiving
Appropriate Care, 2002-2004




Source: HSAG, 2004-2005 External Quality Review Technical Report for Colorado
Medicaid Managed Care, Colorado Department of Health Care Policy and Financing
Using Existing HEDIS Measures –
Postpartum Visit
   Postpartum care (access/availability of
    care): % of deliveries that had a
    postpartum visit on or between 21
    days and 56 days after delivery
    – 2005: Average % of women who received a
      post-partum visit 21-56 days after delivery was
      81.5% for commercial and 57% for Medicaid
      health plans

   Chance to provide preconception advice in
    preparation for subsequent pregnancy
Source: National Committee for Quality Assurance, 2006 The State of Health Care
Quality 2006
Modifying Existing HEDIS
Measures for Preconception
Care – Preventive Visits
   Ambulatory or Preventive Visit (access/ availability of
    care): Percentage of adults ages 20-44 who had an
    ambulatory or preventive visit
     – 2005: Average % of adults who received a
       ambulatory or preventive visit was 92.7% for
       commercial and 76.4% for Medicaid health plans

   Stratification by gender

   Chance to provide preconception advice in
    preparation for initial and/or subsequent pregnancy
Other Possible HEDIS Measures
for Preconception Care
   CDC recommendations list preconception risk
    factors, these could be linked with existing HEDIS
    measures. E.g.,
     Alcohol misuse: HEDIS measure Initiation and Engagement
        of Alcohol and Other Drug Dependence Treatment
      (stratified by ages 20-44 and gender?)
     Hep B: HEDIS measure Adolescent Immunization Status
      (extended to ages 20-44 and stratified by gender?)
     STD: HEDIS measure Chlamydia Screening, Ages 16-25
      (extended to age 44 and stratified by gender?)
     Smoking: HEDIS measure Medical Assistance with Smoking
      Cessation (stratified by ages 20-44 and gender?)
Source: National Committee for Quality Assurance, 2006 The State of Health Care
Quality 2006
Other Proposed Measures of
Preconception Care Quality
   Working group of OB/GYNs and
    perinatologists proposed 90 potential
    indicators for maternal quality of care
   Indicators chosen for
    preconception/interconception care:
    Rubella status
    Pap smear testing
    Diabetic screening
    Folic acid use
                  Korst et al., 2005 Maternal and Child Health Journal, 9(3)
NCQA Process to Add a
HEDIS Measure
   7 months: Initial selection and development

   9 months: Field testing

   12 months: Revision, public comment, vote,
    and addition to existing set of measures

TOTAL: 28 months
State Medicaid/SCHIP
EQRO Contracting
   Development and validation of new
    performance measures of preconception and
    interconception care, as defined by state

   Focus study on perinatal care, preconception
    care, interconception care, as defined by
    state

   PIP on perinatal care, preconception care,
    interconception care, as defined by state
P4P – Definition
   Payor (public and private) strategies to
    reorient payment incentives and instill
    accountability by rewarding efforts to
    improve quality
   Part of broader quality improvement effort
   Both financial and nonfinancial incentives
    may be used to improve measurable
    performance
   Incentives should encourage and reinforce
    use of evidence-based practices that
    promote better outcomes efficiently
Source: Abramson, S. & Younger, K. Pay-for-Performance Literature Review,
Washington, DC: Department of Health Policy, GWU, SPHHS, May 2006.
P4P - Goals

 Improve quality of care
 Reduce variation in patterns of care

 Facilitate access to care

 Integrate evidence-based medicine

 Improve efficiency

 Ensure accountability

Source: Abramson, S. & Younger, K. Pay-for-Performance Literature Review,
Washington, DC: Department of Health Policy, GWU, SPHHS, May 2006.
P4P – Evidence of Impact
on Quality
   Limited evidence of direct impact on quality

   One study by Rosenthal (2005)
     – No impact of financial incentives for hemoglobin
       A1c testing and mammography; small positive
       increase in cervical cancer screening
     – Lowest performers at baseline improved the
       most, but received smallest share of bonus
       payments; best performers at start were biggest
       winners
Source: Abramson, S. & Younger, K. Pay-for-Performance Literature Review,
Washington, DC: Department of Health Policy, GWU, SPHHS, May 2006.
P4P - Incentive/Penalty
Arrangements
   Financial
    –   Challenge/bonus pools for performance rewards
    –   Withhold/recoupment from payments
    –   Auto-assignment
    –   Enrollment frozen
    –   Health plan non-renewal


   Non-Financial
    –   Public reporting (e.g., report cards, newspaper articles)
    –   Public acclamation (e.g., public awards by Mayor)
    –   Partnership between MCO’s and DHS staff with commitment to quality
    –   Waiver of administrative requirements
Source: Abramson, S. & Younger, K. Pay-for-Performance Literature Review,
Washington, DC: Department of Health Policy, GWU, SPHHS, May 2006.
HEDIS and P4P

   Good starting point for P4P measures
   Nationally validated and comparable
    measures
   However, limited measures of
    preconception and interconception
    care
   Focus is on process, not outcome
Source: Abramson, S. & Younger, K. Pay-for-Performance Literature Review,
Washington, DC: Department of Health Policy, GWU, SPHHS, May 2006.

				
DOCUMENT INFO
Shared By:
Categories:
Tags:
Stats:
views:4
posted:9/12/2011
language:English
pages:78