Audio CD and written materials of AIS's audioconference on March 16, 2006

Health Plan Pay-for-Performance Results: Recent Clinical and Financial Outcomes

Some health plans now have several years of experience with quality incentive programs that reward physicians and hospitals for meeting quality standards for patient satisfaction and preventive, acute and chronic care. Find out what clinical and financial outcomes two pioneers in the pay-for-performance (P4P) arena have achieved in their programs for physicians and hospitals. Learn how their successes may be applied to your P4P plans.

Sponsored by Atlantic Information Services, Inc., publisher of Managed Care Week

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With heightened focus on health insurance premiums and the quality of care provided to enrollees, more managed care plans are developing pay-for-performance programs intended to fully engage physician and hospital partners, align financial incentives and bring about lasting improvements in the quality of health care. But how effectively are these programs achieving these goals?

Hear executives from two major health plans describe the structure of their P4P programs and highlight their clinical, utilization and financial results. You will also gain valuable insight into the lessons learned in their program development and refinement.

WellPoint, Inc. subsidiary Blue Cross of California launched its program, based on the plan's Quality Scorecard, in July 2001. Last summer, the Thousand Oaks, Calif.-based plan paid $66 million to 196 physician groups throughout the state based on the providers' performance on the Quality Scorecard and on other contract terms.

Excellus Health Plan started its physician program in 2003, partnering with 900 physicians who are members of Rochester, N.Y.-based Rochester IPA and provide care for 300,000 HMO enrollees. The physicians have a bonus pool of up to $15 million. The insurer also has a hospital P4P program now in its second year. The plan has calculated a large return on investment on the physician P4P program, based on medical cost savings.

Find out:

Managers throughout your organization will learn about effective P4P strategies that generate positive clinical and financial outcomes.

Speakers

JEFF KAMIL, M.D., is vice president and chief medical officer of Blue Cross of California, a subsidiary of WellPoint, Inc. Dr. Kamil is responsible for quality medical management programs for Blue Cross of California commercial and senior membership. He is a member of the board of directors of the Integrated Health Care Association and serves on the committee on performance measurement of the National Committee for Quality Assurance. Dr. Kamil joined Blue Cross of California as medical director in 1997. From 1988 to 1997, Dr. Kamil was a senior manager for Prudential Health Care. A board certified pediatrician, Dr. Kamil was the medical director of Hawthorne Community Medical Group from 1980 to 1987.

CARRIE B. FRANK is vice president of network performance support at Excellus Health Plan. She is responsible for helping to identify opportunities to assist providers to improve their performance, thereby improving the quality and affordability of health care for the plan's members and communities. She joined the company in January 2004. Previously, she was with Caduceus Consulting Group, where she provided strategic, financial and operational improvement consulting services to the health care industry. She also served as executive vice president and chief operating officer for Kaleida Health, and was chief financial officer and chief operating officer at Buffalo General Hospital. Frank is the former chair of the board of directors of the Western New York Healthcare Association, and former chair of both the Quality and Finance Committees of the Healthcare Association of New York State.

Moderator: Jill Brown, managing editor of AIS's Managed Care Week

 

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