Centers for Medicare & Medicaid Pay for Performance Updates Jeff Flick Regional Administrator CMS, Region IX February 7, 2006
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1 Centers for Medicare & Medicaid Pay for Performance Updates Jeff Flick Regional Administrator CMS, Region IX February 7, 2006 Slide -1
2 Big Changes in Medicare New orientation toward prevention Personalized help for people with special conditions and chronic healthcare issues Slide -2 Assistance for Low-Income Beneficiaries
3 Changes in Medicare Keeping up with Today s Healthcare Medicare is converting from a bill paying bureaucracy and a one sized fits all program, to an agency providing personalized help and benefits to beneficiaries. Slide -3
4 Changes in Medicare Keeping up with Today s Healthcare Traditionally, Medicare has not communicated with beneficiaries, it has been a standard set of national benefits focused on paying for complications. New focus on prevention and avoiding complications of chronic illness. Slide -4
5 Personalizing Medicare Services The drug benefit is the first big step in personalizing services. There are a lot of choices and benefits that can be tailored uniquely to beneficiaries Slide -5
6 Personalizing Medicare Services It is not enough to just change the benefits. We must help educate beneficiaries to understand the new benefits and to use them wisely Much of the education and communication with beneficiaries will be accomplished by working through providers, hence the need for pay for performance Slide -6
7 Slide -7 Improving Performance
8 Changes in Medicare Keeping up with Today s Healthcare Medicare has a fundamental interest in re-structuring the payment system. Medicare is no longer going to pay based purely on volume; the days of the more you do the more you get paid are about to end. Slide -8
9 Changes in Medicare Keeping up with Today s Healthcare Medicare intends to become a value based purchaser Medicare will measure performance Medicare will pay at least partially based on performance Slide -9
10 Medicare Today Slide -10 We pay for the wrong care much of the time (45%) We pay for inappropriate care We pay for unnecessary care We pay for mistakes and errors We pay for many duplicative diagnostic studies We must do better- we cannot afford to continue on this path
11 Medicare Today Medicare wants to pay for the right care for every patient every time Medicare wants to pay for all of the care needed by beneficiaries that is supported by science Medicare wants to pay for all of the appropriate preventative care for all beneficiaries based on scientific standards P4P is not cost control in disguise, Medicare wants to pay for performance Slide -11
12 Performance is Measuring patients experience of care Measuring and rewarding based on efficiency and eliminating waste and unnecessary costs Measuring ability to use evidence based care Measuring appropriate use of preventive care Slide -12
13 Paying for Performance through Demonstrations CMS currently pays for quality through a series of demonstrations (all must be budget neutral) A large number of quality demonstrations were mandated in MMA Slide -13
14 Current P4P Demonstrations Premier Hospital Reporting Physician Group Practice Demonstration Slide -14 DOQ-IT (Sec 649) CCIP / Medicare Health Support BIPA Disease Management / Heart Partners High Cost Beneficiaries Medicare Health Care Quality (Sec 646)
15 What CMS Really Needs We need a good Medicare Advantage model for doing P4P inside the expanding MA program. Is anyone here aware of a good P4P program? Slide -15
16 Stay Informed Through Region IX Stakeholder Call Every 3 rd Thursday of the Month, 2-3pm PST Next call March 16, 2006 Toll Free: Pass Code: Stakeholder Call Leader: Jeff Flick Register for CMS Region IX Stakeholder ListServ for notification and details about calls through: Slide -16
17 Thank You! Jeff Flick Slide -17
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