Rewarding Provider Performance Aligning Incentives in Medicare (2007) / Chapter Skim
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6 Monitoring, Evaluation, and Research: Future Directions
6 Monitoring, Evaluation, and Research: Future Directions
Pages 133-142
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From page 133... ...
6 Monitoring, Evaluation, and Research: Future Directions CHAPTER SUMMARY Pay for performance is one important means by which reimburse ment mechanisms can be realigned to promote quality health care. Given both its considerable potential to impact care and the limited experience to date with implementation of such a program, a pay for-performance program in Medicare should be closely monitored and evaluated so its design and use can quickly be modified to reflect experience gained in the real world.
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134 REWARDING PROVIDER PERFORMANCE learning system that is intrinsic to the design and activities of the program. Such a learning system would build on previous experiences and enable Medicare to better fulfill its congressional mandate to serve beneficiaries.
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MONITORING, EVALUATION, AND RESEARCH: FUTURE DIRECTIONS 135 The first report in the Institute of Medicine's (IOM's) Pathways series -- Performance Measurement: Accelerating Improvement -- identified measures of potential value as well as gaps in existing measures to be filled through directed research (IOM, 2006b)
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136 REWARDING PROVIDER PERFORMANCE consequences -- disseminated to those who need to make use of them. This learning system will require definition and coordination at the national level; the Medicare program is well positioned to take the lead in implementing this function.
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MONITORING, EVALUATION, AND RESEARCH: FUTURE DIRECTIONS 137 · Team learning -- a process of using and enhancing the capabilities of individuals within the system, including ongoing dialogue, to achieve the shared vision. Effective learning organizations also have strong leaders involved in creating the guiding ideals of the system, committing to and managing the shared vision, and helping to empower the individuals in the system.
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138 REWARDING PROVIDER PERFORMANCE BOX 6-1 Factors Necessary for Effective Learning to Take Place Shared vision Leadership Empowerment of the workforce Culture enabling learning from mistakes Consumer focus Commitment to teamwork Knowledge management systems Education, training, and development needs analysis Appraisal, performance, and personal development plans Identified and protected education and training budget Opportunity to apply new skills and knowledge Sustained change and improvement Time for learning and reflection Feedback and evaluation SOURCE: Garcarz et al., 2003. further research.
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MONITORING, EVALUATION, AND RESEARCH: FUTURE DIRECTIONS 139 measures based on their contribution to achieving identified goals, and attribution of responsibility among multiple providers participating in the care of a single patient -- have already been identified as high-priority areas for further research to better asses the true impact of payment incentives. Development of an Evidence Base Many conclusions in this report are based on an analysis of reasonable alternatives rather than a firmly established, rich evidence base.
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From page 140... ...
140 REWARDING PROVIDER PERFORMANCE · Is risk adjustment necessary to balance effectiveness and fairness? · How can a pay-for-performance program promote efficient health care without compromising clinical quality or patient-centeredness?
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MONITORING, EVALUATION, AND RESEARCH: FUTURE DIRECTIONS 141 in particular the domains of clinical quality, patient-centeredness, and efficiency, and should also be focused on enhanced care coordination. Research should attempt as well to build an evidence base upon which the design of future pay-for-performance programs can be based.
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