Hudson Health Plan Receives Prestigious Grant To Evaluate Physician Incentives As A Tool To Fix Disparities In Diabetes Care

Main Category: Diabetes
Also Included In: Primary Care / General Practice
Article Date: 05 Jun 2008 - 4:00 PDT

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Hudson Health Plan has received a $197,000 grant from the Robert Wood Johnson Foundation (RWJF) to measure the effectiveness of pay-for-performance (P4P) incentives to physicians in reducing disparities in diabetes care for racial and ethnic minorities, announced Georganne Chapin, President and CEO, today. The grant, awarded as part of RWJF's national program, "Finding Answers: Disparities Research for Change," will help fund a pioneering study to evaluate whether incentive bonuses can guide physician behavior and improve the quality of care for minority patients. Minority group members account for approximately 75 percent of the 77,000 individuals enrolled in Hudson Health Plan, a not-for-profit managed care organization providing free and low-cost public insurance in the lower Hudson Valley.

"We are delighted to receive a grant from Robert Wood Johnson Foundation, the United States ' largest philanthropy devoted exclusively to health and health care," explained Ms. Chapin. "It is significant that we, a relatively small health plan serving low-income people, have been recognized by such a distinguished national program." She stressed the far-reaching consequences of the project, saying, "All of the research shows that there are health care disparities by income, race, and ethnicity. While we endeavor to serve all of our members equally, we want to fully understand what interventions and best practices will help reduce these disparities."

The grant was given to conduct an evaluation of Hudson Health Plan's existing diabetes pay-for-performance (P4P) program, "Supporting Excellence: Rewarding Quality Diabetes Management." The project will gather clinical and claims data for approximately 1,700 Hudson Health Plan members with diabetes, 18 years and older, and evaluate whether providing physicians with patient- specific actionable information, coupled with incentive bonuses, spurs physicians to consistently deliver high-quality care. The project also will track these members' hospitalization rates and emergency room visits to quantify whether quality care reduces utilization rates. Janet (Jessie) Sullivan, MD, Chief Medical Officer of Hudson Health Plan, will serve as principal investigator of the study. Her co-principal investigator will be Meredith B. Rosenthal, PhD, Associate Professor of Health Economics and Policy at the Harvard School of Public Health. Dr. Rosenthal is acknowledged to be one of the nation's leading experts in P4P research.

Pay for Performance Holds Promise

Nationally, health care leaders have embraced P4P as a way to provide financial support for physician investment in processes and technology that facilitate best practices, such as managing diseases by following evidence-based protocols of care. For example, patients with diabetes should have their A1C (blood hemoglobin), which indicates blood glucose levels, tested every six months. Many P4P programs include "outcomes" measurements to reward physicians for meeting or exceeding a set benchmark, e.g., the percentage of patients whose blood sugar is controlled.

However, a potential unintended consequence of P4P is that it could discourage physicians from treating low-income and minority patients - who may be sicker or less likely to comply with regular testing and examination - for fear doing so will drag down a practice's quality scores.

"The Hudson Health Plan P4P program is designed to be supportive of physicians with the sickest patients and fewest resources," noted Dr. Sullivan. "We remove the incentive to cherry pick patients by rewarding physicians for each patient whose health status improves." For example, a doctor is eligible for a bonus when a patient, among other things, successfully reduces blood glucose, even if the number remains higher than the optimal level. Typically, P4P programs reward physicians only if a significant percentage of all patients reduce blood glucose to the recommended level. "We believe pay-for-performance programs will be most effective when they are designed to reward patient-centered care," Dr. Sullivan explained. "The RWJF grant will allow us to do a thorough evaluation of our program to ensure that it reduces, rather than exacerbates, disparities."

Research results are expected to be available in late 2009. Initial validation, sorting and analysis of the data of Hudson Health Plan members with diabetes will be conducted at the Plan. The Plan will remove the patients' names from the data set and send it to Dr. Rosenthal at the Harvard School of Public Health, who will conduct the formal evaluation of the program's results.

"If we demonstrate that promoting regular monitoring and testing of all diabetes patients improves their health and reduces emergency care and hospitalization, Hudson Health Plan's 'Supporting Excellence: Rewarding Quality Diabetes Management' could become a model for others to use to reduce disparities among minority patient populations," explained Ms. Chapin. "Our hope is that the program can be replicated by other health plans to raise diabetes outcomes for all low-income patients in general, and racial and ethnic minorities in particular."

About Hudson Health Plan

Founded in the mid-1980s by a coalition of community health centers, Hudson Health Plan'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 77,000 members in New York's Hudson Valley. Hudson Health Plan 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.

Hudson Health Plan is the winner of the 2006 Poughkeepsie Journal Diversity in the Workplace Award; the 2005 Dr. Martin Luther King Jr. Corporate Award for Diversity from the YWCA of White Plains and Central Westchester; the 2005 Advancements in Health Care Award from Hudson Valley Life and Hudson Valley Parent; and the 2003 Community Leadership Award from The New York Health Plan Association. Visit Hudson Health Plan on the Web at http://www.hudsonhealthplan.org.

Hudson Health Plan