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Buy-Right for Health Care Quality: Evidence and Indicators: Paying for Performance

Slide Presentation by Robert S. Galvin, M.D.

On October 21, 2004, Dr. Galvin made a presentation in a Web conference entitled Buy-Right for Health Care Quality: Evidence and Indicators: Paying for Performance.

This is the text version of Dr. Galvin's slide presentation. Select to access the PowerPoint® Slides (239 KB).

Quality-Based Purchasing and Public Reporting: The Evidence Base and Practical Tools

Robert S. Galvin, M.D.
October 21, 2004

Slide 1

The Strategic Fit of Pay-For-Performance

This slide contains a chart showing the four different stages of the Pay-for-Performance model. This chart is embedded in a scale where the vertical axis, labeled "Values of Health Expenditures," is scaled between high value of health expenditure and low value of health expenditure. A time scale is labeled at the bottom as "Key Evolutionary Steps" and is scaled from 2002 to 2012.

The stages are in the form of circles which progress on an upward slope diagonally to the right. The 4 stages are labeled as:

  • "Performance Comparisons for Hospitals, MDs, and Tx": labeled at the top of this circle is "Transparency."
  • "Increased (arrow-up) Market Sensitivity to Hospital/MD Quality and Cost": labeled at the top of this circle is "Incentives and Rewards."
  • "Clinical Re-engineering by MDs, Hospitals, and suppliers": Labeled at the top of this circle is "Enabled by IT."
  • "Quality (INCREASE signified by an arrow-up)/ Cost (DECREASE signified by an arrow-down)."

Slide 2

Growing Number of Initiatives

This article contains a Leapfrog compendium on the left. On the right, the following bullets are displayed:

  • 78 Initiatives.
  • Easy to Access
  • Commonwealth Fund Sponsored.

Slide 3

Bridges to Excellence

Diabetes Care Link

Using Evidence-Based Literature and Actuarial Analysis


  • Quality Care Saves $350/Diabetic/Year.
  • Purchaser Keeps $175.
  • Physicians Get $100/Patient Incentives $75.

All Payers:

For Practice with 100 Diabetics—$10,000/Year
For Diabetes Clinic with 1,000 Diabetics—$100,000/Year

Slide 4


  • Doctors Signing Up . . . . . . . . .But Slowly.
  • Rewards Being Paid Out . . . . But Not Enough.
  • Payers Expanding. . . . . . . . . . But Not Fast Enough.
  • Patient Incentives Present . . . But Not Sufficiently Robust.
  • Evaluations in Process . . . . . .But Business for Quality Still Unproven.

Slide 5

The Leapfrog Model

This slide contains a grid chart. The horizontal axis is labeled "Effectiveness (Actual v. Expected Complications)" and ranges from 150% to -150%, and the vertical axis is labeled Efficiency (Actual v. Expected) and ranges from -40% to 40%. Hospitals are placed in various places within the graph and are represented by shaded circles where the size of the circle corresponds with the number inside the circle. These hospitals are labeled outside the circle from A to G with a number in each circle. The grid coordinates are also labeled below:

Hospital A: 15 (130%,15%)
Hospital B: 58 (5%,15%)
Hospital C: 26 (40%, -10%)
Hospital D: 10 (70%, -30%)
Hospital E: 83 (-25%, -25%)
Hospital F: 11 (-45%, -30%)
Hospital G: 8 (-100%, -30%)

Slide 6

Big Questions

  • Funding.
  • 'Zero Sum Game'.
  • Sufficient Reward.
  • Provider Engagement.
  • Measures.
  • Professionalism.
  • Trade Associations.
  • Equity.
  • Risk Selection.
  • 'Managing to the Measure'.
  • Safety Net Providers.
  • Leadership.

Current as of March 2005

Internet Citation:

Quality-Based Purchasing and Public Reporting: The Evidence Base and Practical Tools. Text version of a slide presentation at a Web conference. Agency for Healthcare Research and Quality, Rockville, MD.

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