February 26, 2010

VMG again reaches quality incentives

VMG again reaches quality incentives

In 2005, BlueCross BlueShield of Tennessee began paying financial incentives to physicians for meeting contractually agreed clinical quality targets.

For five straight years since then, Vanderbilt Medical Group has met every single target.

Payments to VMG for last year's performance under the incentive program will roll in over the course of 2010, as a 1.2 percent premium atop this year's fees for services to BlueCross-insured beneficiaries.

VMG has similar pay-for-performance agreements with the Vanderbilt Health Plan and with HealthSpring, a Medicare Advantage plan.

“Clinicians and hospitals can increasingly expect both commercial and government payers to offer higher reimbursement for clinical quality and for practice patterns that help keep down unnecessary costs,” said Bev Coccia, director of Managed Care Sales and Service for VUMC.

“And Vanderbilt, in part because of its exceptional clinical IT capability, is in a position to prosper as these incentives become more common.”

The agreements with BlueCross have hinged on levels of preventive services provided to the approximately 5,600 BlueCross beneficiaries who are followed by a VMG adult primary care provider.

The clinical quality targets for 2009 were:

• mammograms every two years for female patients age 40 and older — at least 87 percent completion;
• annual eye exams for patients with diabetes — at least 52 percent completion;
• annual blood glucose-level testing for patients with diabetes — at least 88 percent completion;
• annual blood cholesterol-level testing for patients with diabetes — at least 85 percent completion.
• prompts about pneumonia vaccination sent to unvaccinated patients age 60 and older — at least 75 percent completion;
• prompts about colorectal screening (colonoscopy every 10 years, sigmoidoscopy every five years) sent to overdue patients ages 50 to 75 — at least 75 percent completion.

An agreement with BlueCross on 2010 clinical quality targets is pending.
Later this year the Adult Primary Care Center plans to begin introducing the medical home concept into practice.

“At Vanderbilt, we've been developing capabilities to track and manage chronic disease across large populations, and we've had great success in the pay-for-performance programs we've participated in,” said Jim Jirjis, M.D., M.B.A., chief medical information officer and medical director of Adult Primary Care.

“By design, the tools and processes we're building should scale throughout the organization, to multiple specialties across multiple patient conditions. This BlueCross partnership is an early fruit of the effectiveness of our innovations.”

VUMC's Center for Health Promotion and Disease Management (CHPDM) has focused exclusively on assisting clinicians to carry through on contractually targeted disease management and prevention.

The center's seven staff nurses continually survey information on contractually defined patient groups, checking whether agreed clinical guidelines are being followed — a task greatly aided by the Vanderbilt electronic medical record and other internal databases. When action is needed, the center's nurses notify patients and clinicians.

Nurses at the center are also able to insert reminders into the medical record that are triggered to pop onto the clinician's screen as he or she initiates an exam for a patient who is due for a preventive service.

Julie Scott, R.N.

Julie Scott, R.N.

Julie Scott, R.N., is manager of the Center for Health Promotion and Disease Management.

“Each year when we receive the BlueCross member file, it lists the measures we are targeting, and, based on claims data, what BlueCross has for our compliance,” Scott said. But an insurer's claims data stretches back only to the patient's enrollment date, and many preventive services have longer time scales, “so it turns out that, according to claims data, we're frequently below the targets.

“Without the intervention of the nurses at CHPDM in tracking down the medical history of these patients, Vanderbilt wouldn't be able to show that it is meeting the targets.”

In 2008, through the partnership of clinicians and CHPDM nurses, the rate of current colorectal cancer screening for Vanderbilt Health Plan beneficiaries followed by a VMG adult primary care provider increased from 40 percent to 76 percent; current mammograms increased from 46 percent to 78 percent; and pneumonia vaccination for older beneficiaries increased from 47 percent to 86 percent.