Tarrytown, NY — November 5, 2010…Although many health insurers offer pay for performance (P4P) bonuses to reward doctors for quality care, policy experts continue to debate how to design and implement these programs. But now researchers have singled out a P4P program, designed by Hudson Health Plan, for its effectiveness. The program, which rewards pediatricians for fully immunizing children at the age of two, is the focus of an article to be published in the December, 2010 issue of the Health Services Research Journal, “Improving Timely Childhood Immunizations through Pay for Performance in Medicaid-Managed Care,” by Alyna T. Chien, MD, MS, who is a pediatrician at Children’s Hospital Boston; and Zhonghe Li, MS and Meredith B. Rosenthal, PhD., both of the Harvard School of Public Health.The study behind the article was supported by a grant from the Commonwealth Fund.
The article reports that from 2003 to 2007, Hudson’s immunization rates for two-year-olds jumped from 60% to approximately 80%. This increase for Hudson enrollees was 11% greater than that of other New York Medicaid Health Plans when comparing 2003-2007 data.
The article’s authors credit Hudson’s “distinctive ‘piece rate’ P4P program” for outperforming comparable plans. A “piece rate” program pays doctors a bonus for every Hudson member who is fully immunized. Most P4P programs pay bonuses based on the practice’s overall rate of fully immunized patients.
“Our own data showed that immunization rates for our members had improved, but we knew that rates had also improved state-wide and we wanted a rigorous independent evaluation of the program,” explains Janet Sullivan, MD, Chief Medical Officer of Hudson. “We were gratified to see that the study confirmed improvement greater than other comparable Medicaid health plans.”
Hudson’s program, Supporting Excellence in Childhood Immunization and Screening, pays practices up to $200 for every two-year-old child insured by Hudson who is fully immunized and screened for exposure to lead and tuberculosis. Study authors found the bonus represents a potential increase of 15% to 25% over the basic payment to the primary care practices caring for two-year-olds. To help physicians and nurse practitioners improve their performance, Hudson sends practices monthly lists of patients who have reached their second birthday in the prior month, as well as quarterly reports summarizing each child’s immunization and screening status.
Hudson’s sizeable bonus, along with the reports, have encouraged providers such as Hudson River HealthCare (HRHC) to search for ways to improve care delivery, according to Nancy Walter, RN, MPH, Vice President for Ambulatory Care Services at the federally qualified community health center. When HRHC reviewed patient charts, she says, “We saw we were missing opportunities to immunize the children when they came in sick.” The practice began to vaccinate children in need of immunization whenever they visited. Furthermore, the pediatricians embraced the practice for all children, not just Hudson members, raising the quality of care for all patients. “[The practice] started out with Hudson Health Plan, but eventually it went across the board,” Ms. Walter points out.
Hudson now uses similar incentives to reward providers for quality care for patients with diabetes. For more information about Hudson’s Supporting Excellence program, please visit: www.hudsonhealthplan.org/providers/supporting-excellence.
About Hudson Health Plan
Founded in the mid-1980s by a coalition of community health centers, Hudson’s mission statement is “to promote and provide access to excellent health services for all people.” The Tarrytown-based not-for-profit organization provides comprehensive medical and dental coverage to more than 100,000 members in New York’s Hudson Valley. Hudson has been driving health care innovation by developing technology to support clinical quality initiatives and to streamline the enrollment process for Medicaid Managed Care, Child Health Plus, and Family Health Plus. According to A Consumer’s Guide to Medicaid Managed Care in the Hudson Valley, it has earned the highest ratings in overall satisfaction among Medicaid Managed Care members in the Hudson Valley region every year since 2003.