SAN FRANCISCO – Payers at the Fourth National Pay for Performance Summit in March shared the results of their P4P programs, reporting some areas of success while noting the programs are still evolving.

BlueCross BlueShield of Tennessee, or BCBST, launched its transparency program in 2008 to measure and publish quality data using HEDIS-based quality metrics. Physicians report their own data, which is ranked and posted online, said Marc Loizeaux, manager of BCBST’s Provider Performance Assessment Analytics.

Of the 13,022 BCBST network providers, 2,518 providers have quality ratings online. The self-reporting tool was deployed by 232 providers, and 129 providers saw their rank increase according to the 2007 data. The use rate could be better, Loizeaux said.

Although they use the same measurements, BCBST’s P4P program and public reporting are separate because the P4P program’s six-month contract with network physicians isn’t aligned with the yearly data collection for the transparency program, Loizeaux said. A number of measures will be added.

“We still have to figure out a lot of stuff,” he said.

Lawrence An, MD, of the University of Minnesota, conducted a random study to determine the success of BCBS of Minnesota’s P4P program for smoking intervention, which incents clinicians to refer patients to a telephonic quit-line service.

The intervention group referred 11.4 percent of smokers, compared with the 4.2 percent referral from the usual care clinics. The rate of patient contact after referral was 60.2 percent, with 49.4 percent of those contacted enrolling in the smoking cession program.

Blue Cross of California implemented a one-year P4P program in 2007 to reduce the cost trend in medical surgical, skilled nursing facility, outpatient surgery and emergency departments, said Kurt Tamaru, MD, managing medical director for Anthem Blue Cross. Medical groups worked to meet per-member-per-month (PMPM) cost targets based upon their historical trend. If their PMPM was below target, they shared in the cost savings at the end of the measurement year.

Of the 91 medical groups that participated, 43 received a total of $11 million in P4P payments, with an average payment of more than $300,000.

There were numerous weaknesses in the program, including lack of reward for high achievers, Tamaru said. Modifications were made for the 2008-2009 program, which he described as “another generation program.”