Fixing health care is at the top of everyone’s list these days. The solutions for how to fix the system come from many arenas, with much of the focus being directed at changing consumer behaviors and purchasing patterns, and improving how health care is delivered. While both of these aspects are important – in fact, improving quality and care delivery is a key focus for the Buyers Health Care Action Group (BHCAG) – the health care dilemma cannot be fixed if we do not address the fact that the current payment system is broken.
BHCAG believes that pay-for-performance is one solution to the payment conundrum our country is mired in. Why? Because pay-for-performance programs, such as Minnesota Bridges to Excellence, begin to shift the focus away from paying health care providers for transactions to paying for outcomes. More importantly, pay-for-performance programs drive results.
For instance, the Minnesota Bridges to Excellence program has helped to improve the level of care for people with diabetes, vascular disease and depression. When the program began in 2005, only 6 percent of Minnesotans with diabetes were receiving optimal care. Today, more than 37 percent¾a 600 percent increase¾are receiving optimal care, as determined by guidelines established by the Institute for Clinical Systems Improvement. Patients with vascular disease and depression have also seen improvements.
The reason that Minnesota Bridges to Excellence – and public reporting in general – has been so successful in Minnesota is because the efforts align public and private purchasing objectives. Private sector purchasers and public purchasers, such as the State of Minnesota, the University of Minnesota and the Department of Human Services, have come together to define and communicate common performance standards that are important to the health of all Minnesotans. Their expectation is that all patients are given the same level of high quality care, and information about clinic outcomes is available to the public. Through Minnesota Community Measurement, consumers can check on the quality of the care provided by their clinic in comparison to other clinics.
No other state has made the kind of progress that Minnesota has when it comes to pay-for-performance. The Minnesota Bridges to Excellence program has been identified as a national example of a successful, value-based, public-private purchasing initiative.
Accountable Care Organizations (ACOs) are another example of efforts to fix a broken payment system. And again, Minnesota leads the nation with ACO care delivery models. In fact, Minnesota has experimented with the ACO concept since 1997, when BHCAG rolled out Choice Plus. The premise behind the ACO concept is to hold health care providers accountable for redesigning care delivery with a focus on coordinating care and achieving specific outcomes. At the same time, providers assume financial responsibility for delivering care for a specific cost, and can bear both upside and downside risk associated with the cost of the care they actually deliver.
So, if Minnesota has a proven, successful pay-for-performance initiative, measures outcomes and publicly reports results – all of which are key to improving quality and care delivery – then why are these efforts at risk?
Because the recent Health and Human Services Omnibus bill (Article 5, House Section 13) calls for the elimination of payment incentives for performance by the State of Minnesota.
To move away from the progress and success Minnesota has achieved in improving health outcomes through pay-for-performance when the rest of the nation is moving toward this model would be a grievous mistake.
BHCAG is working diligently to educate political leaders about the importance of pay-for-performance programs and Minnesota Bridges to Excellence. We encourage you to lend your voice to this effort. Please contact Carolyn Pare to learn how you can support Minnesota’s continued commitment to reforming the health care payment system through pay-for-performance programs.
In the meantime, BHCAG will be announcing the reward recipients of the 2011 Minnesota Bridges to Excellence program in early July. We will provide more information about the clinics that qualified and the recognition event to honor our state’s top-performing clinics in the coming weeks.
To learn more about BHCAG programs and initiatives, to attend an event, or to find out how you can lend your voice to reform efforts, please contact us at 952-896-5186 or at firstname.lastname@example.org.
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