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Minnesota Medical Association turns tables on insurers by ranking their P4P programs

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The Minnesota Medical Association yesterday published a report examining and evaluating Minnesota’s pay for performance programs.

According to the Star Tribune, the MMA examined the various health plans and government programs and evaluated their pay-for-performance programs on how well they meet the MMA’s criteria for effective incentives programs — driving improvements in quality care strengthening the physician-patient partnership, including physicians across medical specialties and using valid measures.

The association turned the tables on insurers by ranking nine of the so-called pay-for-performance programs. The Centers for Medicare and Medicaid Services ranked at the top while Bridges to Excellence, a program used by large, self-insured employers, was at the bottom. Programs by Blue Cross Blue Shield of Minnesota, UCare, PreferredOne, HealthPartners and Medica fell somewhere in between. The insurers said they were working with the association to address the concerns, though they didn’t necessarily agree with all of them.

One shortcoming noted in the report is that Minnesota’s pay-for-performance programs rarely adjust for differences in the severity and complexity of the patients’ condition. This can result in an apples-to-oranges comparison that doesn’t really capture differences in the care provided, the report said.

The MMA report urges Minnesota’s health plans, employers and others that use pay-for-performance programs to take the following steps:

  • Adopt a common measurement set, preferably one developed by MN Community Measurement, and a streamlined data collection process in order to reduce the administrative burden; (This would help reduce health care costs and give physicians more time to spend with their patients.)
  • Provide financial incentives for care coordination, especially for patients with chronic illnesses;
  • Provide financial incentives for implementing health information technology and electronic medical records;
  • Eliminate financial penalties for providing care that is in the patient’s best interest; (A physician shouldn’t be penalized for prescribing a brand-name
    drug rather than a generic if that’s what the patient needs.)
  • Ensure that programs don’t penalize physicians who accept patients with complex and difficult conditions.

MMA releases Pay for Performance report

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