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APHA Scientific Session and Event Listing

Irena Pesis-Katz, ABD¹, Peter Veazie, PhD², Kathleen Curtin, NP, MBA³, Norman Lindenmuth, MD¹, and Howard Beckman, MD, FACP⁴. (1) Medical Affairs, Excellus BlueCross BlueShield, 165 Court St., Rochester, NY 14647, (585)530-6741, irena_pesis-katz@urmc.rochester.edu, (2) Community & Preventive Medicine, University of Rochester, 601 Elmwood Avenue, Box 644, Rochester, NY 14642, (3) Quality Management, Excellus Health Plan, 165 Court st., Rochester, NY 14647, (4) Rochester Individual Practice Association Inc., 3540 Winton Place, Rochester, NY 14623

Research objectives: Pay for Performance (P4P) financial incentive programs are playing an ever-growing role in today's quality improvement efforts. The objective of this study is to evaluate the P4P impact on physicians' behavior in diabetes management.

Methods: The study compares quality of care in Diabetes between three health plans using Health Plan Employer Data and Information Set (HEDIS) data. One plan, Excellus Blue Cross Blue Shield of Greater Rochester area (BCBSRA) served as the intervention group. The intervention consisted of a P4P program that incorporated (1) profiles with patient registries mailed to individual physicians three times a year, (2) interactive educational programs stressing measures of interest, and (3) year end distribution of dollars based in part on the diabetes measures. The control groups consisted of a competitor contracting with the same physicians in the same community (HMO A) and another Excellus HMO in a neighboring city (HMO B). A second analysis compares the rate of improvement in HEDIS scores between 2004 and 2003 for BCBSRA and each of the other two HMOs. HMOs A and B employed usual improvement methods in their environments. The study uses HEDIS scores for the individual physician. Each physician's scores were compared to the specialty average and to a goal score. Individual performance profiles were sent to each physician starting October 2002. Financial incentives based on these profiles were allocated as of July 2003.

The study population included all diagnosed diabetes members defined by HEDIS inclusion criteria from the three commercial HMO plans in upstate NY.

Results: BCBSRA, with the P4P intervention, performed significantly better than HMO A or B. For 4 out of the 7 HEDIS diabetes measures BCBSRA had statistically significant increases in rates between 2003 and 2004. HMO A and HMO B improved in only 1 out of 7 diabetes care measures. A comparison of the rate of improvement reveals that BCBSRA also performed significantly better in 6 out of 7 diabetes measures than HMO B and performed significantly better than HMO A in 4 out of 6 diabetes measures.

Conclusions: This study suggests that financial incentives to physicians can contribute to improved quality of care, as measured by accepted HEDIS diabetes measures, when compared to a non-financial control group. Furthermore, because HMO B and BCBSRA utilize the same physicians, the improved results in diabetes quality scores for BCBSRA suggest that physicians responded specifically to the P4P financial incentive and profile/registry reporting.

Learning Objectives:

• Describe Pay-for-Performance payment incentive program, designed to improve quality of care.
• Evaluate the impact of Pay-for-Performance program on diabetes quality of care in the community setting.

Presenting author's disclosure statement:

Any relevant financial relationships? Yes

Organization	Clinical/Research Area	Type of Relationship
Excellus BCBS	health services research	Employment (includes retainer)

Any company-sponsored training?	No
Any institutionally-contracted trials related to this submission?	Yes
Have you received salary support, retainer, or other monies to support your position as part of the research/clinical trials?	Yes
Have you served as the Principal Investigator) for the research/clinical trials?	No
Have the results of your research/clinical trials been published?	No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.