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Pay for Performance Solutions

Pay for Performance or P4P refers to a set of initiatives undertaken by various healthcare insurers and payers to try to improve the quality of care provided by physicians and hospitals by tying a small (but growing) portion of their reimbursements to patient care outcomes.

In practice this means that payers identify a set of criteria related to patients meeting a certain profile and then periodically ask care providers to report on how often they meet those criterion for those patients. For example a payer might specify that all diabetic patients must have an Hb A1c test every six months and that their A1c value be below 9%.

These programs raise two categories of issues for care providers, namely:

1. They need to know, at the point of care, what criteria they will be judged against and
2. They need to put fairly complex processes in place to measure and report on how well they performed against these criteria at the end of the measurement period.

DiagnosisONE provides an easy to use product to help organizations provide real time P4P alerts to care providers and eliminate the administrative reporting burden imposed by multiple P4P programs. We incorporate all national P4P quality measures in our standard offering. We also offer the only product available today that can create and deploy provider and payer specific rules for you on-demand.

Real Time Clinical Alerts

If your physicians and other care providers are going to be graded on specific criterion they need to be able to identify those criterion at the point of care. Additionally, you only want to notify them of the criterion that apply to th payer responsible for the specific patient they are examining at the time.

Our industry leading Clinical Decision Support product D1.Pathway is the only product available today that can support payer and provider specific rules. D1.Pathway is designed as a web service that can be integrated with your Hospital Information, EMR or other point of care system to monitor clinical processes in real time and to deliver P4P related alerts to these systems as patient information is updated. Based on a natural language rules engine D1.Pathway can be customized for each payer and provider without the need for any programming and can support complex rules that can integrate diagnosis, lab and pharmacy information in real time from multiple systems.

Reporting and Analysis

P4P programs impose a significant reporting burden on your nursing or administrative staff, distracting them from more productive tasks. The reporting requirements of these programs are very complex and will require extensive training for these staff. Tracking all the different codes that need to be reported for the 1000s of different combinations of scenarios also creates a significant risk of reporting errors that can reflect poorly or your organization's image.

D1.Pathway eliminates the reporting burden by coding and tracking the required measures on an on going basis and then a creating the required reports on-demand. This functionality can save you 100's of staff hours each reporting period and ensure 100% accuracy in the reports your organization generates.