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Physician Performance Measurement & Reporting Getting Started

There are several strategies that enable employers to actively participate in strategies to improve quality and health outcomes by utilizing data from physician performance measurement and reporting initiatives:

1. Obtain the data results from health plans

2. Partner with other employers and coalitions

3. Build communication and create awareness with consumers

4. Help steer consumers in the decision-making process through information, tiered performance networks, and benefit design

5. Encourage health system efficiency and reform through performance-based incentives

Step 1: Obtain the Data Results from Health Plans

First, employers should make physician practice-level reporting an important discussion point when working with health plans. This level of performance information will help employers with plan selection, contracting processes, performance guarantees, and improvement discussions. Ask health plans which measures are required for reporting by physicians and how these results impact population health and outcomes.

Does the health plan use the Healthcare Effectiveness Data and Information Set (HEDIS) measures or another measure set? Does the health plan encourage accreditation or certification programs, such as NCQA? Reflecting upon claims data, inquire about the percentage of physicians who meet the measure requirements or receive accreditation. Then, determine how this information can be translated into consumer-friendly information (Step 2, below). Develop provider directories or direct consumers to websites that include performance information and information about quality health care.

Step 2: Partner with Other Employers and Coalitions

Second, employers should partner with other employers and coalitions to encourage health plans to work with physicians for performance measurement and reporting. Employers need to communicate which measures or conditions should be included in performance or network evaluation and quality improvement initiatives. NBCH’s eValue8 RFI tool can be used to facilitate discussions with health plans. Employers can work directly with health plans to assess the provider networks using performance reports or other tools such as eValue8. eValue8 is a national Request for Information (RFI) tool to business coalition members and their employers to evaluate performance metrics across health plans in a comparative manner. The tool includes a variety of measures, such as HEDIS measures, that health plans are asked to publicly report.

Step 3: Build Communication and Create Awareness with Consumers

Most performance measurement initiatives developed by health plans include a public reporting component, a tool that can be easily utilized by employers. Health plans, Aetna and UnitedHealthcare for example, use these types of initiatives for network tiering and plan design. Most reporting initiatives focus on both quality of care and cost efficiency—components that represent value to healthcare purchasers and consumers.

First, employers should look at health plans’ websites or websites developed by health care organizations like the National Committee for Quality Assurance (NCQA). These public reporting websites list physicians’ performance achievements (sometimes with symbols such as a star-rating) and/or designations achieved (accreditation or certification). Some health plans provide reports directly to employer customers about physicians’ performance results, which are useful for plan and product decision-making, so ask health plans for these details (refer to Step 1).

Then, determine the appropriate method(s) for communicating performance information with employees—perhaps in the form of a provider directory. CIGNA’s provider directory is an example of a communication tool. Communication materials should be written in a way that builds rapport and offer support for employees. Emphasize the importance of selecting a physician based on these performance measures. Consumers should be able to understand the measures and how the measures impact overall health and safety.

Communication materials should include the following information:

  • What is a measure? Discuss the idea of a checklist for physicians to provide complete care.
  • Why are measures important? Discuss how performance impacts health outcomes.
  • What is my doctor’s performance? Distribute a provider directory or website that shows physicians’ ratings or performance results
  • How do I obtain more information? Provide a contact person to answer questions.

Step 4: Help Steer Consumers in the Decision-Making Process

Employers should provide employees with access to information and support tools in the health care decision-making process. Performance measurement and reporting initiatives, especially those offered through health plans, can serve as information vehicles for consumers to select a physician and understand a physician’s performance in providing high-quality, efficient care.

Ask health plans for a report that includes physician performance results, as this will help with plan design details. Then, employers can work with health plans to customize the plan design to create incentives, such as a reduced co-payment or coinsurance, for employees who receive care from physicians in high-performing networks or physicians who meet measure requirements. Incentives can have an impact in the decision-making process because it reduces out-of-pocket costs. Or, employers can work with health plans to create network tiers using the performance results.

Network requirements may include numerous elements such as:

  • Quality measures
  • Efficiency measures
  • Cost of care evaluation
  • Health information technology adoption
  • Other measures as specified by the health plan

Step 5: Encourage Health System Efficiency and Reform

Employers should collaborate with each other to convene health plans and discuss data results for quality improvement initiatives with performance measurement and reporting components. Evaluating the collective data enables employers and health plans to better understand the system outcomes and the effectiveness of these initiatives. Furthermore, pooling performance data helps to improve practice measurement efforts and provide better, statistically-reliable results.

Performance measurement and reporting serves as a foundation for payment reform, which is discussed in more detail in the Physician Payment Reform chapter of the VBP Guide. Employers can work with health plans to examine how performance-based incentives can impact the current provider networks. Ask health plans if a percentage of provider reimbursement is tied to performance. If not, use examples of case studies of care models, such as pay-for-performance programs like Bridges to Excellence, that incorporate quality improvement and performance-based incentives to improve care delivered to patients. Creating efficiency in the health care system involves partnerships and collaboration among all stakeholders, so it is important for purchasers to understand their role in emphasizing the value of care in terms of quality and efficiency.

Next: Additional Resources

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 National Business Coalition on Health.
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Payment models that reward providers for performance in quality and efficiency based on predetermined benchmarks, such as meeting pre-established performance targets, demonstrating improved performance, or performing better than peers in the delivery of health care services. Often abbreviated as ""P4P"". P4P payments are typically made in addition to fee-for-service payments.
The extent to which care delivered by a physician conforms to evidence-based guidelines, based on their adherence to evidence-based guidelines and/or the health of the patient population they manage.
The extent to which care delivered by a physician conforms to evidence-based guidelines, based on their adherence to evidence-based guidelines and/or the health of the patient population they manage.