Changing reimbursement models requires changes to physician compensation models – the value of unblinded performance metrics

Cynthia KilroyIn my final blog related to changing reimbursement models requiring changes to physician compensation models, I want to identify the value of sharing unblinded information once physicians have approved, digested and absorbed the compensation model.

Many of the organizations I have talked to find unblinded incentives to be a very powerful tool. However, you need to make sure that you have the alignment and agreement with the physicians and that people believe in the metrics, because if you share metrics that are incorrect or not of value, you have lost the opportunity to change that behavior.

The value of unblinded information is multi-faceted, but ultimately it should create reliability and trust within the physician community if you have implemented the model using a transparent process. From a reliability perspective it eliminates the “black box” approach, thus reducing skeptics. Hopefully, reliability and transparency will foster a culture of trust and respect throughout the organization. Many of the challenges of payers measuring physician performance is that the measurement calculations are traditionally blinded and having a payer dictate how to practice can be frustrating for physicians, consequently creating an adversarial relationship.

Another benefit of unblinded information is that it provides motivation to change behavior. I know many groups who offered this information to physicians who saw significant change in some of the “low” performing physicians, because they understood what they needed to do to improve outcomes and reimbursement.

Presenting information unblinded allows physicians to self-police themselves – poor performance is quickly addressed by peers. As part of a bigger issue poor performers can impact the entire group’s performance, ultimately impacting performance-based incentives and shared savings.   Unblinded information offers referring physicians objective criteria to ensure their patients are cared for by high-performing physicians. For example, if a PCP refers to an orthopedic surgeon who has a readmission issue, it will reflect badly on the PCP and impacts his own outcome measures.   The benefit of the self-policing and referral management allows the group to drive to clinical affordability consistent with the goals of the triple aim.

Unblinded information, used in a thoughtful way, is a powerful tool for physician groups entering into value-based contracts.

About the author

Cynthia Kilroy

Ms. Kilroy has over twenty years of experience as a healthcare professional focused on helping clients conceive and implement strategic decisions that change the concept of the business they are in to meet emerging challenges and market needs.  Currently, Ms. Kilroy is SVP of Solution Strategy and Business Development for Optum Consumer Solutions Group and is the designated Provider Market Lead.  Cynthia is accountable for business and product strategies to position Optum consumer health, financial management and population care management capabilities to meet the strategic needs of the market.

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