With pay-for-performance evolving from the "check-the-box" model, providers need to learn to work within teams that can understand these new programs, explained Mitzi Wasik, PharmD, BCPS, director of Pharmacy Medicare Programs at Aetna, Inc.
With pay-for-performance evolving from the “check-the-box” model, providers need to learn to work within teams that can understand these new programs, explained Mitzi Wasik, PharmD, BCPS, director of Pharmacy Medicare Programs at Aetna, Inc.
Transcript (slightly modified for readability)
How have pay-for-performance programs changed and evolved along with the healthcare system these last few years?
The healthcare system has historically been a “check-the-box” pay-for-performance (P4P) type model. And we still have that in some situations, but on the longitudinal basis, we’re measuring adherence, we’re measuring readmissions, and there’s penalties, there’s payments tied to it. There are many health plans that if they don’t get this right, they’re not going to survive in the current marketplace. So there’s always a push for quality improvement.
Stakeholder accountability is also something that has changed where previously it was “the physician” and now it’s “the team.” So look at accountable care organizations and how are those teams being built and structured? And who within the provider’s office is taking responsibility for these initiatives?
One provider can have 10 different health insurers with their P4P models and physicians are trying to treat the patient, so they need that person in house to be able to take these programs an unfold them: how to make them work. You need that office manager that has all of the quality improvement experience or the pharmacist.
Some of the most successful groups we’ve worked with have pharmacists embedded in them or nurses who have been working in quality for years so they understand it and they get it. So it’s just part of the normal day-to-day activities and work within the physician’s practice.