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Problem:
A selected RPNavigator client wanted to pilot a
Pay for Performance (P4P) initiative in a metropolitan area to prove
its value, demonstrate their ability to smoothly implement such a
program and improve provider satisfaction with the Plan.
Solution:
Our Client used RPNavigator’s Practice
Management Index (PMI) to create a balanced scorecard whose meaning was
transparent to providers and which could demonstrate the Plan’s commitment to
enhancing the coordination and quality of care. The utilization was case mix and severity adjusted by primary
care specialty and excluded the top 2% of cost outliers. Because of these features, physicians
appreciated the fact that all observations about utilization differences had
been adjusted for variations in burden of illness and were benchmarked against
same-specialty peers. Physicians received regular feedback including periodic
reports on their performance along with financial incentives based on their
performance.
Results:
Physicians were impressed with the quality and depth of information on their members, since it
contained clinically germane aspects of utilization about which they were often
unaware. It enabled them to perform targeted outreach to their patients who needed follow-up, with evidence-based
quality of care recommendations. As a result of its success, the Plan is now considering expanding the program to the
entire network. In addition, the PMI is being used to provide all physicians important feedback at the time of their
re-credentialing.
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