Participating in pay-for-performance (P4P) programs can work out well for both provider and payer. By “performing well” on certain clinical and administrative measures, savings are created that can be shared with both parties. That is, if providers can meet specific metrics that appear to produce some savings by, say, coordinating patient care better or ensuring that the population is receiving timely preventive care, then everyone wins and costs go down.
However, it can be a little perilous to participate in these programs if you don’t have a good understanding of your own data. Signing up to meet specific goals without first knowing where you currently stand or without being able to monitor progress as you go along a defined time period can mean falling short of expectations and losing out on additional revenues. So, it is vital that you must be able to run reports in your own system to either validate or dispute the data that the payer will be producing, in terms of how your providers have performed. Depending on your IT infrastructure, this may or may not be an easy task!