# Presentation: 161833

## Evaluation of the Rewarding Results ProgramGary Young, J.D., Ph.D.Boston University School of Public Health andDepartment of Veterans AffairsBoston, MA

- Young 2004

## Rewarding Results: Seven Demonstration Projects

| DEMONSTRATION PROJECT  | UNIT OF ACCOUNTABILITY  | GEOGRAPHIC REGION  |
| --- | --- | --- |
| Blue Cross Blue Shield of Michigan | Hospitals | MI |
| Blue Cross of California | Individual physicians | San Francisco Bay area |
| Bridges to Excellence | Individual physicians
& Group practices | Cincinnati, OH
Louisville, KY
Boston, MA
Albany, NY |
| Excellus | Individual physicians | Rochester, NY |
| Pay for Performance – Integrated Healthcare Association | Group practices | CA |
| Local Initiative Rewarding Results – Center for Health Care Strategies | Individual physicians & Group practices
 | CA
 |
| Massachusetts Health Quality Partners | Group practices | MA
 |

- Young 2004

## Quality Targets

- Scoring
- 75% threshold
- 67%, 75% thresholds
- 83% threshold
- % improvement

- Selected quality targets
- HbA1c screening
- Diabetic eye exam
- Mammography
- Well-child visits

- Young 2004

## Withhold (5% - 20% of claims) 
Block bonus potential to group (e.g. $60,000/40 primary care physicians; $1.2 million/280 primary care physicians)
PMPM bonus potential for total panel (e.g. $1.50 per member per month; $3.00 per member per month)
Hybrid: withhold and bonus
Enhanced fee schedule in subsequent year

- Block bonus potential to group (e.g. $60,000/40 primary care physicians; $1.2 million/280 primary care physicians)
- PMPM bonus potential for total panel (e.g. $1.50 per member per month; $3.00 per member per month)
- Hybrid: withhold and bonus
- Enhanced fee schedule in subsequent year

- Financial Incentive Arrangements

- Young 2004

## Conceptual Framework:  Financial Incentives and Quality 

**  **_**Quality **_
_**Targets**_

_**Feedback**_

- Conceptual Framework:  Financial Incentives and Quality

_**Provider Perceptions**_
**Awareness**
**Financial salience**
**•****Scientific/clinical  credibility**
**Scope of control**** **
**Fairness**** **
**Unintended consequences **

- Young 2004

## Slide 6

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## Slide 7

- Young 2004

**Notes:**
Data reported in this slide are based on the subgroup of respondents (n=560) who indicated awareness of a particular target & incentive on which to base their responses to Section 2 of the questionnaire.

Dimensions on which statistically significant differences were observed are circled.  The p values were as follows:
Credibility: p<.001
Control: p<.05
Fairness: p<.05
Unintended consequences: p<.001
Impact: p<.01  

## Telephone Interviews with Physician Practice Leaders

- Importance of dollars
- Complexity of distribution formulas
- Clinical relevance of quality targets
- Validity of data
- Role of individual physicians (physician-centered vs. system-oriented)

- Young 2004

## Conclusions

- Physician attitudes may differ from public commentary
- Providers appear confused about administration of programs
- Providers are comfortable with clinical relevance of quality targets but are not impressed with the associated dollars

- Young 2004