International Workshop:
Pay for Performance
Can it Improve the Quality and Value of Israeli Healthcare?
September 2-3, 2009, Caesarea, Israel

September 2, 2009

8:30 – 9:30     Registration + Light Breakfast
9:30 – 11:00   Welcome Session - Chair: 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 - Chair: 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) Sect: 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. health care. 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, electronic health records, VHA system underwent a transformation so sweeping that RAND investigators found it generally outperformed other settings. Toward informing discussion of performance measures and health information technologies in improving value, this session examines the parallel challenges and opportunities in the VHA experience and other health care settings.

Open Discussion

13:00 – 14:00   Lunch

14:00 - 15:30  Session 3 - Chair: 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 - Chair: 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

September 3, 2009

09:00 – 11:00   Session 5 - Chair: 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 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.

Chair: Joshua Shemer
HMO's Panel: Zeev Aharonson, Nicky Lieberman, Ehud Kokia, Daniel Vardy

Chair: Yair Shapiro
Hospital's Panel: Rafael Beyar, Yair Birnbaum, Orna Blondheim

11:30 – 11:00  Coffee Break

11:30– 13:00    Session 6 - Chair: 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 - Chair: 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, 4 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