Identifying a physician champion, one that is truly leading the charge, is one the six elements of a best practice project of a pay-for-performance program, says Julie Hobson, RN, BSN, manager of provider engagement, performance and partnership at Highmark Inc.
The best practice component is one of the unique aspects of a pay-for-performance program and it has been very rewarding to us as well as to practices. This is looking at two types of a process improvement. It may be office-based, where a practice looks at a specific disease state and measurement within that disease state to provide a higher quality of care to patients. Or, they can undertake a professional organization certification program.
Requirements of the best practice project that have helped the practices in becoming successful includes the following:
- There has to be a physician champion identified and one that is truly leading the charge. Not only should there be a physician champion, but most likely there will be clinical champions as well to help drive it.
- The implementation of the initiative must be within one year of the submission.
- There must be a baseline measurement and it does cross all members or all patients in the practice, not just our Highmark members.
- The initiative they take should cover a large population of the practice and not a small part because of the effort that they put into it. The rewards that they receive are better for a larger population.
- The sixth and final element is the practice reporting to us the lessons they’ve learned in implementing the process and also identifying how they will sustain the success that they have achieved through the implementation of the program.
Guide to Value-Based Reimbursement: Profiting from Payment Bundling, PHO Shared Savings, and Pay for Performance explores emerging models of episode-based payments, physician-hospital organizations and physician bonus structures, including bundled payments, PHO success and physician pay-for-performance and bonus structure.