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International Workshop: Pay for Performance Can It Improve the Quality and Value of Israeli Health Care? Chairmen: Ronni Gamzu

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International Workshop: Pay for Performance Can It Improve the Quality and Value of Israeli Health Care? Chairmen: Ronni Gamzu International Workshop: Pay for Performance Can it Improve the Quality and Value of Israeli Health Care ? Chairmen: Ronni Gamzu Charles N. Kahn September 2-3, 2009 Caesarea, Israel Paying for Performance. Now. In his pioneering paper entitled "Uncertainty and the Welfare Economics of Medical Care" Nobel-prize winner Kenneth J. Arrow highlighted the significant role of 'product uncertainty' as one of the special characteristics of the medical care market. Almost 45 years later, the planned health reform in the U.S. includes the advancement of health information to increase the value for money. Paying for performance (P4P) strategies are supposed to increase the quality and value for money. Healthcare policy-makers worldwide pursue structure and process reforms to adjust the growing challenges of the health market. Yet, we all fail to assure ourselves that such innovations improve the quality of care. The state of the reimbursement system between hospitals and HMOs in the Israel healthcare system can be seen as a perfect example. Until recently, the reimbursement system paid hospitals chiefly on the basis on bed days used. The system gradually reformed to include more DRGs in an attempt to increase efficiency. Yet, clinical outcomes and performance remain absent in this equation. It is often claimed that the cost of hospital treatment has more to do with number of physicians, number of medical specialties and the procedures they prefer - than the real health improvement. Any quantity and procedure-based payments are subject to “creative” management (e.g. DRG creep) to maximize tariff revenue. Payers are used to: forgo) the quality issue due to information barriers and overall uncertainty. The Israel healthcare system is not an exception when it comes to notions such as these. The Israel healthcare system is facing many challenges. Most of them originate from the fragmented structure of the system that yields contradictory interests - almost unbridgeable. Maximizing the quality of care should be a consensual interest. To achieve this aim; all parties should embrace reimbursement systems based on quality and performance in a 'risk sharing' manner. The time for P4P is now. Ronni Gamzu THE ISRAEL NATIONAL INSTITUTE FOR HEALTH POLICY RESEARCH Table of Contents Page 1. Workshop Program 4 2. List of Speakers and Chairmen 7 3. Abstracts 9 4. Biographies 21 International Workshop : Pay for Performance Can it Improve the Quality and Value of Israeli Health Care ? September 2-3, 2009, Caesarea, Israel September 2, 2009 8:30 – 9:30 Registration + Light Breakfast 9:30 – 11:00 Opening Session - Chairman: Shlomo Mor-Yosef Yaakov Litzman, Deputy Minister of Health Background and Aims of the Conference: Ronni Gamzu & Charles N. Kahn The Influence of Incentives on Worker Performance Miriam Erez Quality Measurement and Improvement; in Theory and in Practice Charles N. Kahn P4P as a part of International initiatives to Improve the Quality and Value of Healthcare: Now and Tomorrow 11:00 – 11:30 Coffee Break 11:30 – 13:00 Session 2 - Chairman: Yair Birnbaum A Higher Quality and More Efficient Healthcare System in a Diffused and Fractionated Health System; Is this Possible ? Janet Corrigan The purpose of this session is to provide an outline of the discussion on the need to improve the healthcare system in order to provide higher quality of care and greater efficiency. How can one achieve a higher quality and more efficient healthcare system in such a fractionated and diffused system of insurers, providers, and policy makers? What is the importance of “systemness;” can it be accomplished, and can we assume it improves quality when most of the care insured or provided for in the country is so diffuse ? Health System Transformation: Policy, Practice, and Performance Measures in the Private (HCA) and Public (VA) Sectors Jonathan Perlin Improving value in health care is a challenge faced by many countries, especially the United States. The U.S. Veterans Health Administration (VHA) operates independently of mainstream U.S. healthcare. It faced intense scrutiny regarding quality, access, and value and underwent a transition of its operating model from being a “safety net sick care” provider to offering health promotion and disease management. Using broad performance measurement and electronic health records, the VHA system underwent a transformation so sweeping that RAND investigators found it generally outperformed other settings. Toward informing the discussion on performance measures and health information technologies in its improvement of value; this session examines the parallel challenges and opportunities in the VHA experience and other healthcare settings. Open Discussion 13:00 – 14:00 Lunch 14:00 – 15:30 Session 3 - Chairman: Alexander Aviram Measuring the Right Thing - The Key to the Successful Engagement of Physicians and Patients Paul C. Tang Changing health outcomes requires physician and patient engagement. Credible quality measures are shown to lead to sustainable change – both with physicians and with patients. Physician-facing electronic health records and patient-facing personal health records provide essential tools for enabling and maintaining change. How should measures be designed and how should they be applied to motivate, create, and sustain continuous quality improvement by the healthcare team? How is data used to motivate patients to take a more active role in their self-management? Creating a data-driven partnership between physicians and patients drives quality to a new level. Are the Right Things Being Measured ? Elisheva Simchen Choosing the variables for measurement must assume a strong correlation between that which is being measured and the quality of care. Process measurements mandate a clear understanding between the actions to be carried out and the outcomes. Outcome measurements, on the other hand, neglect the developments leading to one particular measure. What is the balance between the two? And what is the impact of measurement selection? Are the right things being measured at the right level? Is it possible to move from process level measures to patient episodes of care measures - and could this lead to more integrated care ? Open Discussion 15:30 – 16:00 Coffee Break 16:00 – 18:00 Session 4 - Chairman: Avi Porath P4P - Like Models - The Israeli Experience Asher Elhayany The Effect of Pay for Performance (P4P) on Quality of Care in the Cardiac Surgery Department. A Pioneer Experiment; Preliminary Results. Ahuva Weiss-Meilik Data will be presented on an experiment performed in a cardiothoracic department in Israel that incorporated a P4P model aimed at improving clinical outcomes. The objectives are to examine the effect of employing the P4P method on process measures and clinical outcomes in CABG and valve surgery . In this session the research outline will be presented and the preliminary results will be demonstrated . Panel Discussion: Ronni Gamzu, Charles N. Kahn, Ehud Raanani, Gideon Uretzky 19:30 – 22:00 Dinner September 3, 2009 09:00 – 11:00 Session 5 - Chairman: Joshua Shemer P4P - Are There Unintended Consequences? Robert Berenson There is very little empirical data that demonstrates one way or the other whether P4P actually does improve quality – and at what cost. Indeed, a recent analysis of the Medicare P4P demonstration concluded that hospitals appear largely unmotivated by the P4P program; although participating hospitals do increase efforts for some easy tasks. What are the major issues that need to be considered in proceeding with P4P regimes? A fundamental question is whether or not providers respond to P4P incentives by positively changing organizational culture or, alternatively, respond by “testing to the test” of what is being measured? These and other issues will be addressed, along with some suggestions for minimizing unintended negative consequences. Chairman: Joshua Shemer HMO's Panel : Zeev Aharonson, Nicky Lieberman, Ehud Kokia, Daniel Vardy Chairman: Yair Shapiro Hospital's Panel : Rafael Beyar, Yair Birnbaum, Orna Blondheim 11:00 – 11:30 Coffee Break 11:30 – 13:00 Session 6 – Chairman: Gabi Barbash HIT- The Challenges Julian Zelingher HIT has been labeled as an enabler of quality enhancement, value, and performance. However, at this point, the evidence about which HIT innovations are the most effective in achieving higher quality and greater efficiency is unclear. What does research suggest regarding HIT’s impact on quality and efficiency? Can we have an efficient and high-performing healthcare delivery system without HIT? The importance of HIT: in this session, the representatives of HIT - which is already in use - will present its advantages in measuring quality. And finally, do we need a unified HIT system for measuring and reporting quality ? Panel Discussion: Gabi Barbash, Eyran Halpern, Joseph Rosenblum, Paul C. Tang 13:00 – 14:00 Lunch 14:00 – 16:30 Closing Session - Chairman: Gabi Bin Nun What Should Be Our Plan of Action? Adjusting the Payment System in Israel. A Working Proposal for P4P over a Two Year Period Ronni Gamzu, Charles N. Kahn The purpose of this session is to offer an economic perspective and to adjust the payment system in Israel to create a working draft of a P4P model for the Israeli system . The P4P model will focus on: “the linkage between payers and providers” (HMO’s – Hospitals), and “the linkage between physicians and employers.” At the end of this session, four opinion leaders will discuss a model draft. Panel Discussion: Robert Berenson, Janet Corrigan, Tuvia Horev, Jonathan Perlin, Paul C. Tang, Avi Israeli Recapping the discussion of the past two days, the practical solutions and policy options are to be explored. Where should the healthcare system be headed and how can we achieve these goals ? Coffee to go List of Speakers and Chairmen Dr. Zeev Aharonson, Medical Director, Meuhedet Health Services Prof. Alexander Aviram , Scientific Director, NIHP Prof. Gabriel Barbash, Director General, Tel Aviv Sourasky Medical Center Dr. Robert Berenson, University of North Carolina School of Public Health and the Fuqua School of Business at Duke University Prof. Rafael Beyar, Director, Rambam Health Care Campus Prof.
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