Managed Care - April 2008 - (Page 44) on its trajectory of value-based purchasing, it’s BAGLEY: I don’t believe that. They did it in every likely a higher percentage of physician compenother industry. We are just late to the table. It sation will come from programs like this. doesn’t require a lot of sophisticated technology to use a systematic approach to analyzing your MC: You seem to be collaborating with a lot of processes and your outcomes and getting feedother organizations. Is that raising awareness of back. Technology makes it easier, no question. quality reporting as well? BAGLEY: Yes. There seems to be a lot of synergy MC: How would you characterize the extent and going on right now. The American Medical Asquality of collaboration between physicians and sociation has created the Physicians Consortium health plans on these issues? for Performance Improvement, and has been a BAGLEY: The relationship between physicians and major developer of physician-level performance health plans has lacked trust in the past, and now measures over the last few years. They’ve been that they have the potential to work together to working in conjunction with the Centers for improve measurement, quality, and outcomes, Medicare & Medicaid Services, the National the first thing that has to be rebuilt is the trust. Quality Forum, and the National Committee for If a plan comes out with a program to rate physiQuality Assurance to develop physician-level cians based on their quality, their costs, or their performance measures. Another organization is efficiency, physicians immediately don’t trust the Ambulatory Care Quality Alliance, now the them. Health plans are going to have to go a long AQA. The AQA brought together stakeholders way to help physicians understand that there’s from health plans, physician organizations, CMS, value in having this feedback, and that will only and employers to work on the implementation occur if insurers are able to report these numbers of performance measures. They’ve in a way that doesn’t damage done a great job of pulling people “The relationship physicians’ reputations. This has together, educating everybody, and between physicians to be done very carefully so that we moving toward a more standard- and health plans has build and maintain trust. ized set of measures for the country. MC: What areas are ripe for improved lacked trust in the collaboration? MC: Is performance measurement a past, and now they precondition for quality improveBAGLEY: Health plans now have ment? ways of using their claims data to have the potential to get what is arguably very credible BAGLEY: Absolutely. You cannot man- work together to iminformation about cost and qualage what you don’t measure. We prove measurement, ity. The administrative data set gets have not generally measured much richer all of the time. It’s no longer of the clinical work that we’ve done quality, and outcomes.” just claims data, it’s pharmacy in this country. You have to measure not just your outcomes, which are certainly imdata, laboratory orders, lab results, imaging orportant, but also some of the steps that we are ders, referrals. A lot of that data can be used for fairly certain lead to better outcomes. It’s not quality analysis. Ideally, physicians should be just measuring the number of people who die or able to report quality data from the clinical don’t die because they are treated well for their record, but that’s labor-intensive and very diffimyocardial infarction; we need to measure the cult to do in the current environment. I don’t things that yield better results, like door-tothink health plans are interested in going back 10 balloon time for an acute MI. How long does it steps and asking physicians to send in data. It’s take the care team to get the blocked artery too complex. The ultimate answer, however, is to opened up so the artery doesn’t get damaged? We have people look at that very rich administrative are seeing a tremendous movement toward paydata set thoughtfully and say, if I had these two ing attention to quality and recognizing that or three bits of information from the clinical measurement is foundational. record, it would make this twice as good. Then they can try to strategically collect some addiMC: Is it true that these kinds of initiatives could not tional information to add to the administrative have been done 20 years ago because of the techdata. nology? 44 MANAGED CARE / APRIL 2008
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