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Clinical Preventive Services

Purchaser Role

Presenter:

Michael Bailit, M.B.A., President, Bailit Health Purchasing, LLP, Wellesley, MA.


Healthcare purchasers have become more knowledgeable and assertive in demanding high value for their healthcare dollar. Value-based purchasing strategies can be used not only to improve overall health plan performance and responsiveness to purchasers' interest, but also to achieve objectives in specific areas, such as increasing the utilization of effective clinical preventive services.

Mr. Bailit stressed that good purchasing is about behavior change. Three strategies that States as purchasers can employ to change behavior and increase the provision of preventive care services are:

  • Closely managing contracts with managed care organizations (MCOs) and providers.
  • Providing performance incentives, either financial or non-financial.
  • Collaborating with MCOs and providers on joint improvement efforts.

According to Mr. Bailit, contract management and oversight with MCOs or provider networks is the single most important strategy to promoting clinical preventive services. A pro-active management approach to the contract is essential.

The five aspects of an effective contract management approach are:

  • Defining purchasing specifications by being comprehensive and specific.
  • Identifying opportunities for improvement.
  • Negotiating improvement goals.
  • Collaborating with MCOs to facilitate improvement.
  • Measuring performance.

Performance incentives and disincentives are intricately tied into contract management. Both financial and nonfinancial strategies can be used.

  • Financial incentives, such as performance rebates, must be large enough to command the attention and resources of the plan.
  • Incentives should be reserved for "stretch" goals while disincentives should be used to ensure that basic requirements are met.
  • Performance targets need to be defined up front, and data must be analyzed and verified at the end of the measurement period.
  • Ensuring that contractors do not focus solely on performance tied to incentives can be a challenge. One way to do this is to publicly recognize high performance.

Collaboration to identify the most critical community healthcare issues is the third strategy that State purchasers can employ. Some methods of collaboration are:

  • Conducting joint improvement efforts.
  • Joining committees to develop programs.
  • Lobbying jointly for legislative support.

Specific examples of States that have used these strategies, particularly the use of incentives/disincentives, to promote the use of clinical preventive services include:

  • Maine successfully utilizes performance incentives. Using Health Plan Employer Data and Information Set (HEDIS) measures as their basis, Maine Medicaid assesses the performance of preventive services delivery by primary care case management and fee-for-service primary care providers. Quarterly incentive payments are allotted to physicians performing in the top 20th percentile for that quarter. Physicians have been very supportive of the program thus far. The biggest challenge Maine faces has been ensuring a valid methodology for the target measures.
  • Wisconsin also uses performance incentives. Their biggest challenge has been selecting indicators and setting credible performance targets. Wisconsin encourages collaboration with school districts.
  • Minnesota collaborates with health maintenance organizations to create joint public health goals. For example, the State encourages plans to contact providers about using tools to assess domestic violence. Minnesota then directs that information to county violence prevention programs. The biggest challenge the State faces is getting providers and consumers to change their behaviors and adopt new programs.

Reference

Bailit MH, et al. Vendor management: a model for collaboration and quality improvement. Jt Comm J Qual Improv 1995;21(11).


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