QUALITY IMPROVEMENT

Yes, health care is a business, but altruistic plans would like to cooperate with others. The Leapfrog Group has set up a simple mechanism to do this.

Jerry Salkowe, MD, vice president for quality improvement at MVP Health Care, spent part of a recent weekend entering information about the insurer's quality incentive program into a new Web-based list of such efforts compiled by the Leapfrog Group.

MVP, a health plan based in Schenectady, N.Y., issues payments to primary care physicians who meet specific quality measures. Leapfrog, steadily growing in national influence, is an employer-driven organization attempting to improve quality in patient care.

Leapfrog's Incentive and Reward Compendium makes it easy to learn about what others are doing and tell the story of your organization's efforts, says Salkowe. "I'd be interested in hearing from health plans that have some things in common with our program so that we can share ideas in more detail."

The compendium, which is accessible for free at «http://ir.leapfroggroup.org/compendiumselect.cfm», summarizes more than 80 projects around the country, providing information on program goals, the structure of nonfinancial and financial incentives, and the impact of the programs. The list includes programs run by employers and employer groups, insurers, and government agencies, and it describes incentives that target health plans as well as physicians and hospitals.

"It's important to have an idea of what's going on around the country in terms of pay-for-performance programs," says Stephen Schoenbaum, MD, senior vice president of the Commonwealth Fund, which along with the Robert Wood Johnson Foundation supported development of the list. "We want to keep track of these programs because at some point, people are going to want to know, 'How did these things work out? Did they improve quality or not? What kinds of programs work best in what kinds of situations?'"

To put the list together, Leapfrog staffers built on their own knowledge of various initiatives by searching the Internet to identify more, launching the list with 77 entries, a number that grew almost immediately as organizations began entering their own data.

"It is a living tool," says Claire Turner, Leapfrog's director of communications. "We are enabling people to share best practices for rewards programs, and are providing a venue for purchaser-plan collaboration so everybody can see how it works in other areas. The aim of the compendium is to raise awareness that there are lots of innovative schemes already in place to improve the quality and affordability of health care."

Insurers typically learn about incentive programs through local and national trade group meetings and conferences, as well as through the press. But the comprehensiveness and national scope of the Leapfrog compendium make it especially useful, because it is often difficult to share information with competitors in local markets, Salkowe says.

Leapfrog's list lacks contact information in many entries, but it typically provides a Web address for the initial source of a program's description. It will be a good place to start for organizations that are designing new programs, says Barbra Rabson, executive director of Massachusetts Health Quality Partners, which is working with five health plans to measure the effect of the quality incentives that it offers to physicians. It is also releasing to the public data on the quality of nine physician networks this year and on 180 physician groups next year. "The devil's always in the details, but the compendium gets you started. It gives you a good sense of where to explore further," Rabson says.

'Just the start'

The number of incentive programs will continue to grow, says Schoenbaum of the Commonwealth Fund. "Everybody is talking about pay for performance, just as everyone was talking about tiering not long ago."

For employers, this is "just the start," says Lauren Tran, director of health policy at the St. Louis Area Business Health Coalition, a purchasing group that has had financial incentives tied to health plans' improvements in clinical quality since 1996.

"As employers get more sophisticated, they are likely to undertake more national efforts in terms of reward programs."

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