New York Quality Alliance
In 2005 state legislation created a Pay for Performance (P4P) Demonstration program with a $10 million appropriation over two years to facilitate multi-payer collaboratives. The statute directed the Commissioner of Health to convene a workgroup of providers and payors to develop clinical measures and metrics to measure provider performance and to support up to five competitively bid demonstration projects involving multiple payors using the measures developed by the workgroup. The workgroup met four times and developed a set of hospital and ambulatory measures for the P4P demonstration program. The Department of Health (DOH) issued a Request for Applications (RFA) for the P4P demonstration program in May of 2006. The New York Health Plan Association developed a collaborative proposal in response to the RFA. In March of 2007 HPA was notified by the state that the New York Quality Alliance (NYQA) proposal would receive $3.2 million in state funds.
The New York Quality Alliance (NYQA) is comprised of representatives from health plans, physician groups, businesses, consumers and government. The NYQA is funded to develop a uniform data aggregation and reporting project that will promote statewide quality performance improvements among health care practitioners.
Physician Alliance
The New York Chapter of the American College of Physicians (ACP) provides staffing to the Physician Alliance (PA) that works as part of the NYQA on provider outreach, training and education activities for physicians and the consumers.
Data Aggregation Infrastructure
Participating health plans submit data to a central data aggregator. Standardized physician report cards on performance are generated using all participating payors, eliminating the problem of “dueling report cards,” which confuse consumers and mystify providers. Participating health plans receive reports from the data aggregator and will pay out quality bonuses directly to physician or groups who meet their benchmarks for incentive payments. State grant funds are used to match the health plan payments to physicians. Participating health plans measure the same performance areas but are completely independent to design the incentive program and payment structure. Anti trust laws prohibit plans from working together to design payment bonuses to physicians.
Standard Uniform Evaluation
A strong, independent, credible project evaluation will be employed to provide information about the effectiveness of the program overall; allow comparison of the relative value of the various regional interventions and to determine what works, what works better and what costs more without returning better value. The members of the NYQA will work with the identified evaluator to develop evaluation criteria for the project.
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