BWPO Pay for Performance Update
The Brigham and Women’s Physicians Organization (BWPO) has outperformed budget projections of 75 percent and expects to get back 80 percent or $3.8M of the risk funds withheld by BCBS, HPHC and Tufts Health Plan (THP). Despite this strong return in 2005, significant challenges lie ahead in order to continue to maximize withhold return.
The health plan performance goals become more difficult every year. This is a direct result of getting increased fees from the health plans. “In order to continue enjoying higher than average fees, we must continue demonstrating higher than average performance,” said Dr. Allen Smith, BWPO chief medical officer, when outlining the BWPO’s medical management strategy.
BWPO physicians can have the most influence on improving performance in the areas of Inpatient, Radiology and Pharmacy utilization. These measures accounted for 60 percent of the lost withhold in 2005.
In order to improve inpatient performance, “We must continue to educate patients, and, working with our primary care physicians, enroll them in our high risk program, ‘Plan and Promise,’ continue collaboration with Faulkner Hospital and augment the relationship between BWH primary care and all our clinicians, the BWH ED and Faulkner,” Smith said.
The BWPO’s Radiology utilization trend is lower than the PCHI Network; however, there is room for improvement. There is significant variation in the use of imaging between physicians in the same practice and same sub-specialty. In order to reduce variation, the BWPO management strategy calls for clinicians to use Percipio themselves, thereby maximizing the advantage of computerized decision support with peer-to-peer communication as backup. Also, the BWPO plans to pilot a program that will disseminate and review image ordering variation reports with physicians in a target sub-specialty.
Significant variations exist within practices in Pharmacy trends, as well, specifically with the use of antihistamines and proton pump inhibitors. The BWPO is focusing on increased practice reporting, promotion of e-prescribing and continued educational efforts for physicians and patients.
In the quality arena, pay for performance targets are beginning to change from goals that focus on screening high percentage of target populations to goals that require that high percentage of patients achieve target outcomes. For example, ensuring that high rates of diabetic patients achieve target HbA1c or LDLs. “This represents an enormous opportunity to improve the health of patients with chronic disease,” said Louise Schneider, MD, who leads diabetes care improvement efforts for the BWPO.
To underpin all of these medical management efforts and maximize our clinical integration, the number of physicians using an Electronic Medical Record (EMR) continues to grow. This is especially evident with the Private Staff Physicians who must independently adopt an EMR. So far approximately one-third of the Private Staff Physicians have or are adopting an EMR in 2006. Recent new users of LMR include BWH Cardiac Surgery and our primary care site on Beacon Street.
BWPO physicians have worked hard to get to this current performance level, but in order to achieve maximum withhold return and be well positioned for the next round of health plan negotiations, overall performance must continue to improve. “The good news is with pay for performance targets, we know what we need to do, and with continued support and effort, we should be able to meet these challenges in the coming year,” Smith said.