Pay for performance
Initiatives aim to realign payment with quality and effectiveness
One goal of healthcare reform over the years has been to realign the incentives that influence healthcare quality and effectiveness. Current payment systems typically reward volume; most do not recognize quality or effectiveness of care. They encourage physicians to see patients quickly—sometimes too quickly to provide comprehensive care, particularly for patients with complex or chronic conditions.
Developing systems that reward physicians and other types of providers for quality and effectiveness is an evolving process that begins with establishing which topics to measure and what constitutes quality or high performance. Monitoring these measures gives feedback physicians and providers can use to improve performance. Putting performance information in the public domain can create incentives and is an important step prior to attaching payment to performance.
The Centers for Medicare & Medicaid Services (CMS), managed care plans, and other healthcare payers are actively examining how to lay the groundwork for performance-based incentives that could help improve outcomes and reduce healthcare costs. Acumentra Health is among the Oregon stakeholders serving on the expert panel of the Measuring HealthCare Value in Oregon initiative, which is beginning the task of identifying potential common measures for healthcare performance in Oregon.
Resources and information
Oregon
CareOregon—Care Support and System Innovation program
Provides grants for EHR implementation and other projects based on the six aims for improvement outlined in the Institute of Medicine’s Crossing the Quality Chasm report
Oregon Health Care Quality Corporation (Q Corp)
Convenes stakeholders (including Acumentra Health) to design a uniform approach to primary care performance measures and public reporting
Public Employees’ Benefit Board (PEBB)
Is implementing a “recommended vendor” rating program
Other states
Wisconsin Collaborative for Healthcare Quality
California HealthCare Foundation
National
Agency for Healthcare Research and Quality
Conducts Medical Expenditure Panel Survey, providing annual data on use and payment for medical care; funds research related to quality and effectiveness of care
CMS Nursing Home Pay-for-Performance Demonstration Project
Demonstration project to provide incentives for quality improvement in nursing home care
CMS/Premier Hospital Quality Incentive Demonstration
Demonstration project involving more than 260 hospitals; year one results announced November 14, 2005
The Commonwealth Fund
Funds and publishes research on healthcare coverage and quality, including pay for performance initiatives
Kaiser Family Foundation and kaisernetwork.org
Provides information related to pay for performance (on kaisernetwork.org, search HealthCasts and Daily Health Policy Reports)
RAND
Funds and publishes research on a wide range of health and healthcare topics
The Robert Wood Johnson Foundation
Funds and publishes research on healthcare quality improvement, including pay for performance projects
- News release and related links on the “Rewarding Results” program, a joint initiative with California HealthCare Foundation and the Commonwealth Fund.
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