Enabling Healthy Decisions

I only heard a piece of the presentation yesterday at AHIP (America’s Health Insurance Plans), but I was a little surprised. They were talking about the topic of P4P (pay for performance). The survey population clearly supported P4P for MDs with the primary objective being preventative care and compliance. This focus did surprise me since I imagined it would have been more focused on cost management.

The survey population wasn’t interested in all at P4P for pharmacists. This surprised me a little bit especially given the access differences. Certainly, physicians can impact bigger dollar decisions (e.g., drugs vs wellness or surgery vs other options), but if the focus is on preventative care and compliance, they pharmacists have easy access to the patients.

Pharmacists are a walk-up option. No appointment is needed. Some pharmacists really know their patients. Both parties are really busy so rewarding them for the additional responsibility is appropriate.

I think it was about 20% that thought about rewarding pharmacists and clearly the focus (not surprisingly) was on driving formulary compliance and generics. In many cases, they have rewards to do this today.

If you’re interested in seeing one of the studies out there, here is one on Medicaid. The conclusion was:

“Medicaid directors and their staffs generally report positive feedback on their pay-for-performance programs and believe that the overall quality of care being provided is improving, although they have mixed opinions about cost savings resulting from the programs. Directors are considering changing some of the measures, incentives, and even the data collection strategies to improve their existing programs and to shape planned programs. Overall, they believe that pay-for-performance is adding to their repertoire of tools to improve the care provided to their Medicaid populations.” [K. Kuhmerker and T. Hartman, Pay-for-Performance in State Medicaid Programs: A Survey of State Medicaid Directors and Programs, The Commonwealth Fund, April 2007]