Inconsistent investments and strategies are undercutting the effectiveness of pay-for-performance initiatives in the United States, according to a recent payer-based survey on P4P programs.
Lack of standardization in P4P model and methodology is at the heart of the problem, according to three related reports gleaned from the survey from Health Industry Insights, an IDC company.
Differentiation of pay-for-performance initiatives may be strategic for payers but the variability doesn't help the marketplace, said Janice Young, program director of payer IT strategies for the research and advisory firm.
"Healthcare payers continue to use many different criteria sources and criteria sets," she said in her report. "This variability is expensive, with redundant, fragmented or contradictory program and IT investment across the industry."
Along that theme, multiple definitions of best practices are unsustainable from a provider perspective and negatively affect physician participation.
Last year, payers spent resources getting their P4P initiatives off the ground when they should have focused on sharing information and communicating results with their providers, Young said.
"The importance of shared information and communication is clearly a driving factor, as additional investment in 2007 focused on Web portals for information delivery," she wrote in her report. "This is a critical step in improving program efficiency and, more importantly, provider participation and acceptance."
Payers should focus on reimbursing providers for doing a better job. Young said the best strategy for payers is to put money into a pool, assess providers against a set of criteria and pay providers a percentage of the pool based on the assessment.
Young pointed to the collaborative efforts of the Silicon Valley Consortium and the CMS P4P project for Medicare and Medicaid as the best models available that have the clout in the form of combined purchasing power to push the market to a more integrated P4P model.
Employer-based P4P programs are also a way for outside money to come into the system. "Employers are interested in their own initiatives," she said. "This will have an impact on holding premiums down."
Young noted that reports from the provider side, increased discussions and employer push are driving P4P toward better collaboration and an integrated model.