What innovations drive success in physician performance? Here's a tactic from a leading healthcare system.

The problem

As CEO of Arizona Care Network, an accountable care organization in greater Phoenix, David Hanekom, M.D., needed a physician incentive program that his network of 5,000 primary care doctors could believe in.

Hanekom knew that any new program would gain acceptance only if incentives were effective and quality measures were meaningful to patient outcomes and practice transformation, rather than simply meeting payers' metrics for reimbursement.

The solution

To achieve physician buy-in for a new program, in 2016 ACN's leadership began by working with providers to understand which measurements they considered clinically meaningful. For example, physicians know that by meeting a metric of lowering blood pressure below 140/90 across their panels, they can reduce strokes and heart attacks among their patients.

ACN's leadership then narrowed its focus to clinical and patient-satisfaction metrics that physicians can address across a patient population within a single quarter: HbA1C control, hypertension control, statin use, depression screening, coordinating care within the network, and net promoter score.

ACN built a robust quality-reporting dashboard so that physicians can see in real time how they are performing relative to other physicians, teams, and geographic areas. Physicians' “natural competition," says Hanekom, drives improvement as they see how they are progressing relative to their peers.

Meeting the new set of metrics was also incentivized with a quarterly pool of $500,000 in bonuses. Checks are cut every three months so that physicians are rewarded quickly and frequently, rather than waiting until the end of the year. And those bonuses are above and beyond any gain sharing to which they are entitled as part of the ACO's contracts.

It boils down to “measuring what matters and reporting the clinical outcomes in a very short period," says Hanekom.

The outcome

In the first quarter of 2017, $250,000 was paid out to providers – half of the available incentive pool — a measure of how quickly the program is shifting physician behavior. Hanekom fully expects that amount to increase as physicians review the dashboard searching for opportunities for improvement.

“I'm putting resources in place to make sure the physicians are successful," Hanekom says, "because we foundationally believe that a successful primary care physician, as measured by our physician incentive program, automatically translates to better care, lower cost, more satisfied providers, and more satisfied patients."

Lia Novotny is a contributing writer for athenaInsight.