This study examined the effects of a pay-for-performance program implemented by a leading health insurer in Washington State between 2003 and 2007 that involved quality scorecards, public reporting, and financial incentives for medical groups. The researchers found that neither the scorecard nor the incentive program had a significant positive effect on clinical quality. Specifically, the addition of incentives to the scorecard was associated with a reduction in quality, contrary to the program's goals. The researchers believe the modest incentive amounts, use of rewards only with no penalties, and targeting of groups instead of individuals helped weaken the program's effects. The study contributes to understanding the challenges of achieving successful pay-for-performance.
Four strategies to upgrade clinical trial quality in this computerized world ...Pubrica
• Biostatistics Services is important for collecting, reviewing, presenting, and interpreting data in clinical research.
• Applications of clinical biostatistics services are in different areas, such as epidemiology, clinical trials, population genetics, the biology of structures, and more.
Reference : https://pubrica.com/services/research-services/biostatistics-and-statistical-programming-services/
Continue Reading: http://bit.ly/36nwtcs
Why Pubrica?
When you order our services, Plagiarism free|onTime|outstanding customer support|Unlimited Revisions support|High-quality Subject Matter Experts.
Contact us :
Web: https://pubrica.com/
Blog: https://pubrica.com/academy/
Email: sales@pubrica.com
WhatsApp : +91 9884350006
United Kingdom: +44- 74248 10299
Health outcomes research is seen as a cost-effective investment in measuring and defining value of new innovations in health care. We provide an overview of field and its applications
Four strategies to upgrade clinical trial quality in this computerized world ...Pubrica
• Biostatistics Services is important for collecting, reviewing, presenting, and interpreting data in clinical research.
• Applications of clinical biostatistics services are in different areas, such as epidemiology, clinical trials, population genetics, the biology of structures, and more.
Reference : https://pubrica.com/services/research-services/biostatistics-and-statistical-programming-services/
Continue Reading: http://bit.ly/36nwtcs
Why Pubrica?
When you order our services, Plagiarism free|onTime|outstanding customer support|Unlimited Revisions support|High-quality Subject Matter Experts.
Contact us :
Web: https://pubrica.com/
Blog: https://pubrica.com/academy/
Email: sales@pubrica.com
WhatsApp : +91 9884350006
United Kingdom: +44- 74248 10299
Health outcomes research is seen as a cost-effective investment in measuring and defining value of new innovations in health care. We provide an overview of field and its applications
Pharmacoeconomics is a branch of health economics which compares the value of one drug or a drug therapy to another.
By understanding the principles, methods, and application of pharmacoeconomics, healthcare professionals will be prepared to make better decisions regarding the use of pharmaceutical products and services.
The Mis-measure of Health Care: Can Measurement, Improvement, and Cost Reduct...The Commonwealth Fund
Slides from the lecture "The Mis-measure of Health Care: Can Measurement, Improvement, and Cost Reduction be Reunited?" which was delivered by Eric Schneider MD on Wednesday, May 1, 2019 at The MacLean Center for Clinical Medical Ethics at The University of Chicago.
Policy Implications of Healthcare Associated InfectionsAlbert Domingo
On February 19, 2014 at the Ateneo School of Medicine and Public Health in Pasig City, Dr. Albert Domingo presented an introduction to the economic impact of healthcare associated infections (HAIs) as well as related concepts in health policy and management. The speaker discussed common approaches taken to ascertain the economic impact of HAIs, followed by factors/considerations in Philippine health policy and management that must be understood and adjusted in order to minimize HAIs.
Pharmacoeconomics is a branch of health economics which compares the value of one drug or a drug therapy to another.
By understanding the principles, methods, and application of pharmacoeconomics, healthcare professionals will be prepared to make better decisions regarding the use of pharmaceutical products and services.
The Mis-measure of Health Care: Can Measurement, Improvement, and Cost Reduct...The Commonwealth Fund
Slides from the lecture "The Mis-measure of Health Care: Can Measurement, Improvement, and Cost Reduction be Reunited?" which was delivered by Eric Schneider MD on Wednesday, May 1, 2019 at The MacLean Center for Clinical Medical Ethics at The University of Chicago.
Policy Implications of Healthcare Associated InfectionsAlbert Domingo
On February 19, 2014 at the Ateneo School of Medicine and Public Health in Pasig City, Dr. Albert Domingo presented an introduction to the economic impact of healthcare associated infections (HAIs) as well as related concepts in health policy and management. The speaker discussed common approaches taken to ascertain the economic impact of HAIs, followed by factors/considerations in Philippine health policy and management that must be understood and adjusted in order to minimize HAIs.
Denetim sürecinin , uzak ve yakın geçmişimizdeki yeri ve önemi buna ilave olarak küresel çapta bizleri ilgilendiren skandallar ve 2012 TTK ' sının bizlere getirdiği yenilikler hakkında başlıklarla ve kısa bilgilerle değindiğim bilgileri bulunmaktadır .
Muhasebede defter kaydı yaparken zorlanılan noktalarda işimizi kolaylaştırabi...Metehan Merdim
Bir üniversiteye girmeye hak kazanıp karşınızdaki tahtada daha önce karşılaşmadığınız sayıları , çizgileri gördüğünüzde ve mantığını anlamaya çalıştığınızda birtakım zorluklarla karşılaşmaktasınız . Evet ilk başta gerçekten anlaşılmaz , karmaşık gelebilir , ancak ; Korkmamaya başladığınızda , üstünde çözüme kavuşturacak bir şekilde düşündüğünüzde hatta ve hatta sevmeye başladığınız zamanda kademeli olarak başardığınızı hissedeceksiniz .
Kasa farkı , döviz kuru farkları ve şüpheli alacaklar konularını değindiğim sunumun sizlere faydası olacaksa büyük mutluluk duyarım .
Propunere de model de organizare a examenului de admitere clasa a ix a 2Andra Cretu
Acest model ar aduce beneficii prin simplificare, coerenta, ordine, comunicare si informare facila pentru:
~pentru parinti, elevi, cadre didactice diriginti, profesori;
~pentru personalul din administrarea liceelor: secretariat, directori;
~pentru comunicarea cu inspectoratele si ministerul educatiei
Présentation complète du 1er logiciel de réservation en ligne gratuit pour hébergements touristiques (hôtel, chambre d hôtes, location de vacances, camping...)
NCBI Bookshelf. A service of the National Library of Medicine,.docxvannagoforth
NCBI Bookshelf. A service of the National Library of Medicine, National Institutes of Health.
Institute of Medicine (US) Roundtable on Value & Science-Driven Health Care; Yong PL, Olsen LA, McGinnis
JM, editors. Value in Health Care: Accounting for Cost, Quality, Safety, Outcomes, and Innovation.
Washington (DC): National Academies Press (US); 2010.
5 Approaches to Improving Value—Provider and Manufacturer
Payments
INTRODUCTION
Payment design, coverage policies, reimbursement rules, and other financial incentives and
disincentives are powerful motivators when attempting to steer the healthcare system toward
more desirable care patterns (Guterman et al., 2009). Experiments with payment design and
coverage and reimbursement policies are currently going on in both public and private healthcare
sectors, with varying results. Speakers in this session of the workshop explored current payment
design experiments and discussed the efficacy of utilizing these reimbursement tools to improve
the value received from health care.
In this chapter, Carolyn M. Clancy details the pay-for-performance (P4P) model, an effort to
more explicitly link provider payments to quality of care. She highlights the lack of coherent
approaches to P4P and the variable success this approach has had in fundamentally changing
provider practice patterns. For example, while financial incentives for individual physicians have
shown that P4P can induce quality improvements for diabetic patients (Beaulieu and Horrigan,
2005), group-level incentives have had no impact on mammography screening or hemoglobin A
testing rates (Rosenthal et al., 2005). After underscoring that the current incentive system and
healthcare infrastructure fail to accommodate the achievement of real efficiency and quality, she
outlines recommendations for rethinking medical training, measurement, system design, and the
reward system.
Building on Clancy’s recommendations, Donald A. Sawyer identifies how the current healthcare
system stymies innovation in product development. He suggests refocusing the myopic view of
innovation on the horizon of long-term health improvements and financial savings. Reed V.
Tuckson discusses the alignment of manufacturers, technologists, payers, patients, and providers
necessary to establish a system that continues to provide incentives for innovation and maintains
an open market for the development of promising but unproven interventions. He elaborates
specifically on a joint effort between UnitedHealth Group and the American College of
Cardiology to develop appropriateness criteria for cardiac single-photon emission computed
tomography myocardial perfusion imaging—a new and very expensive technology—based on
best evidence as an example of how the interests of diverse stakeholder groups could be aligned.
In conclusion, Steven D. Pearson likens coverage and reimbursement tools to a blunt knife that
lacks subtlety in effecting value improvements, bu ...
Assignment WK 9Assessing a Healthcare ProgramPolicy Evaluation.docxjesuslightbody
Assignment: WK 9Assessing a Healthcare Program/Policy Evaluation
Program/policy evaluation is a valuable tool that can help strengthen the quality of programs/policies and improve outcomes for the populations they serve. Program/policy evaluation answers basic questions about program/policy effectiveness. It involves collecting and analyzing information about program/policy activities, characteristics, and outcomes. This information can be used to ultimately improve program services or policy initiatives.
Nurses can play a very important role assessing program/policy evaluation for the same reasons that they can be so important to program/policy design. Nurses bring expertise and patient advocacy that can add significant insight and impact. In this Assignment, you will practice applying this expertise and insight by selecting an existing healthcare program or policy evaluation and reflecting on the criteria used to measure the effectiveness of the program/policy.
To Prepare:
· Review the Healthcare Program/Policy Evaluation Analysis Template provided in the Resources.
· Select an existing healthcare program or policy evaluation or choose one of interest to you.
· Review community, state, or federal policy evaluation and reflect on the criteria used to measure the effectiveness of the program or policy described.
The Assignment: (2–3 pages)
Based on the program or policy evaluation you selected, complete the Healthcare Program/Policy Evaluation Analysis Template. Be sure to address the following:
· Describe the healthcare program or policy outcomes.
· How was the success of the program or policy measured?
· How many people were reached by the program or policy selected?
· How much of an impact was realized with the program or policy selected?
· At what point in program implementation was the program or policy evaluation conducted?
· What data was used to conduct the program or policy evaluation?
· What specific information on unintended consequences was identified?
· What stakeholders were identified in the evaluation of the program or policy? Who would benefit most from the results and reporting of the program or policy evaluation? Be specific and provide examples.
· Did the program or policy meet the original intent and objectives? Why or why not?
· Would you recommend implementing this program or policy in your place of work? Why or why not?
· Identify at least two ways that you, as a nurse advocate, could become involved in evaluating a program or policy after 1 year of implementation.
By Day 7 of Week 10
Submit your completed healthcare program/policy evaluation analysis.
Milstead, J. A., & Short, N. M. (2019).
Health policy and politics: A nurse's guide (6th ed.). Jones & Bartlett Learning.
· Chapter 7, “Health Policy and Social Program Evaluation” (pp. 116–124 only)
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5409875/
https://www.sciencedirect.com/science/article/pii/S0029655418300617
i J LUUU^S
.
Partial and Incremental PCMH Practice Transformation: Implications for Qualit...Paul Grundy
Experience of BCBS Michigan in Building medical homes
Based on the observed relationships for partial implementation,full implementation of the PCMH model is associated with a 3.5 percent higher quality composite score, a 5.1 percent higher preventive composite score, and $26.37 lower per member per month medical costs for adults. Full PCMH implementation is also associated with a 12.2 percent higher preventive composite score, but no reductions in costs for pediatric populations. Incremental improvements in PCMH model implementation yielded similar positive effects on quality of care for both adult and pediatric populations but were not associated with cost savings for either population.
Conclusions. Estimated effects of the PCMH model on quality and cost of care
appear to improve with the degree of PCMH implementation achieved and with incremental improvements in implementation.
Patient Satisfaction Survey as a Tool Towards Quality Improvement by Dr.Mahbo...Healthcare consultant
A mixed bag of poorly evaluated methods leaves patients frustrated, and doctors little wiser.The best way to ensure that services are responsive to those they aim to serve is to elicit feedback on people’s experiences and encourage providers to deal with any problems thus identified. This has been axiomatic in health policy for many years, but have we got the balance right in primary care? Patients’ experiences have become central to assessing the performance of healthcare systems worldwide and are increasingly being used to inform quality improvement processes. This paper explores the relative value of surveys and detailed patient narratives in identifying priorities for improving breast cancer services as part of a quality improvement process.
mHealth Israel_Dr Dana Safran_Payment Reform Successes and Challenges_Nov 25,...Levi Shapiro
Presentation for mHealth Israel by Dr Dana Safran, SVP, Performance Measurement and Improvement at Blue Cross Blue Shield of Massachusetts, about "Payment Reform Successes and Challenges", with an emphasis on lessons learned from their Alternative Quality Contract (AQC)
A few months ago I wrote an article entitled Unplanned Readmissions: Are They Quality Measures or Utilization Measures? It explained the Hospital Readmissions Reduction Program (HRRP) that began in October 2012 as part of the Affordable Care Act (ACA). That article explained the program and its results over the past 5 years. However, more and more healthcare leaders and organizations are beginning to question whether HRRP is a valuable program or whether it is time to move on to something that focuses on quality of care and clinical outcomes, rather than cost savings. This article will address those issues. (In this article “readmissions” mean unplanned or preventable readmissions).
Paying for performance to improve the delivery of health interventions in LMICsReBUILD for Resilience
This presentation from Sophie Witter & Karin Diaconu of Queen Margaret University, UK outlines the findings from a Cochrane review undertaken by the team on paying for performance to improve the delivery of health interventions in low and middle-income countries.
Recommendations on Evidence Needed to Support Measurement Equivalence between...CRF Health
Patient-reported outcomes (PROs) are the consequences of disease and/or its treatment
as reported by the patient. The importance of PRO measures in clinical trials for new drugs, biologic
agents, and devices was underscored by the release of the US Food and Drug Administration’s draft
guidance for industry titled "Patient-Reported Outcome Measures: Use in Medical Product Development
to Support Labeling Claims." The intent of the guidance was to describe how the FDA will evaluate the
appropriateness and adequacy of PRO measures used as effectiveness endpoints in clinical trials. In
response to the expressed need of ISPOR members for further clarification of several aspects of the draft
guidance, ISPOR’s Health Science Policy Council created three task forces, one of which was charged
with addressing the implications of the draft guidance for the collection of PRO data using electronic data
capture modes of administration (ePRO). The objective of this report is to present recommendations from
ISPOR’s ePRO Good Research Practices Task Force regarding the evidence necessary to support the
comparability, or measurement equivalence, of ePROs to the paper-based PRO measures from which
they were adapted.
Evidence-Based PracticeEvidence-based Practice Progra.docxelbanglis
Evidence-Based
Practice
Evidence-based Practice
Program
The Agency for Healthcare Research and
Quality (AHRQ), through its Evidence-
based Practice Centers (EPCs), sponsors
the development of evidence reports and
technology assessments to assist public-
and private-sector organizations in their
efforts to improve the quality of health
care in the United States. The reports
and assessments provide organizations
with comprehensive, science-based
information on common, costly
medical conditions and new health care
technologies. The EPCs systematically
review the relevant scientific literature
on topics assigned to them by AHRQ
and conduct additional analyses when
appropriate prior to developing their
reports and assessments.
AHRQ expects that the EPC evidence
reports and technology assessments will
inform individual health plans, providers,
and purchasers as well as the health care
system as a whole by providing important
information to help improve health care
quality.
The full report and this summary are
available at www.effectivehealthcare.
ahrq.gov/reports/final.cfm.
Background
The United States spends a greater proportion
of its gross domestic product on health care
than any other country in the world (17.6
percent in 2009),1 yet often fails to provide
high-quality and efficient health care.2-6 U.S.
health care has traditionally been based on a
solid foundation of primary care to meet the
majority of preventive, acute, and chronic
health care needs of its population; however,
the recent challenges facing health care in
the United States have been particularly
magnified within the primary care setting.
Access to primary care is limited in many
areas, particularly rural communities. Fewer
U.S. physicians are choosing primary care as
a profession, and satisfaction among primary
care physicians has waned amid the growing
demands of office-based practice.7 There has
been growing concern that current models
of primary care will not be sustainable for
meeting the broad health care needs of the
American population.
The patient-centered medical home (PCMH)
is a model of primary care transformation that
seeks to meet the variety of health care needs
of patients and to improve patient and staff
experiences, outcomes, safety, and system
efficiency.8-11 The term “medical home”
was first used by the American Academy of
Pediatrics in 1967 to describe the concept of a
single centralized source of care and medical
record for children with special health care
Evidence Report/Technology Assessment
Number 208
2. The Patient-Centered Medical Home
Closing the Quality Gap: Revisiting the State of the Science
Executive Summary
2
needs.12 The current concept of PCMH has been greatly
expanded and is based on 40 years of previous efforts to
redesign primary care to provide the highest quality of care
possible.13,14 The chronic care model,15,16 a conceptual
model for organizing chronic illness ...
Health Economics In Clinical Trials - Pubricapubrica101
Pubrica specializes in Health Economics in Clinical Trials, offering comprehensive support to ensure the economic aspects of your trial are effectively managed. From cost-effectiveness analysis to budgeting and reimbursement strategies, we help you optimize the economic outcomes of your trial. With Pubrica's expertise, you can navigate the complex landscape of health economics in clinical trials with confidence.
For more information, please refer to our service- https://pubrica.com/blog/research/health-economics-in-clinical-trials/ & Order now - https://pubrica.com/order-now/
Contact Our UK Medical Author’s;
Our email id – sales@pubrica.com
Contact No. +91 9884350006
Running head QUALITY IMPROVEMENT FOR PUBLIC HEALTH FACILITIES .docxtoltonkendal
Running head: QUALITY IMPROVEMENT FOR PUBLIC HEALTH FACILITIES 1
QUALITY IMPROVEMENT FOR PUBLIC HEALTH FACILITIES 6
Quality Improvement for Public Health Facilities
Qualitative Research Methods Evaluation
AIU ONLINE
HLTH 335 1701A - 01
UNIT 2 IP
The type of study in the four listed articles include the following. Article one by Chaudhry et al., (2006) was a qualitative study. The authors conducted a system review from expert opinion and literature review to determine the role that information technology had played in enhancing health care quality, efficiency and costs of medical care. The authors hypothesized that information technology had played a significant role in improving the quality of medical care by increasing adherence to medical guidelines, improving disease surveillance and decreasing medication errors. The type of study for the second article was also a qualitative study that examined 260 hospital on the issue of pay for performance strategy. The authors compared their results to other hospital that did not have the current nationwide pay for performance system, (Werner et al., 2010). The authors hypothesized that pay-for-performance system improved quality health care among hospitals in this system. The third article was also a qualitative study where the authors hypothesized that public reporting of hospital quality data and the pay for performance have emerged as the widely advocated tools for these that accelerate health facility’s improvement (Lindenauer et al., 2007). The fourth article was also a qualitative study article. The authors of the article hypothesized that the Keystone ICU project was associated with a significant decrease on the hospital mortality within Michigan as compared to the surrounding areas, (Lipitz-Snyderman, et al., 2011).
Article one utilized data from published expert opinion and literature search from academic data bases. There was no direct involvement of the human subject when collecting data for this article. Article two utilized data from 260 hospitals. The authors chose acute care hospitals that began operating in 2004. The author’s excluded four critical-access hospitals. Researchers of the third article used 2490 health services providers nation-wide who met the criteria for Hospital Quality Alliance (HQA). In the fourth article, the authors chose the patients who were treated in Michigan’s 95 study hospitals from 238, 937 total admissions. All the samples and the populations for these studies were appropriate.
During the study documentation Chaudhry et al., (2006) reported that hospital facilities documented and reported data on costs and contextual factors. Limitations of data in this article is that the systematic review utilized a mixed data of private and public initiatives into hospital systems. The public and private initiatives have different agendas. Werner et al., (2010), study results indicated that the two groups of hospitals were simil ...
ACT500 Research Evaluation TablesArticle 1 Measuring Perfo.docxbobbywlane695641
ACT500: Research Evaluation Tables
Article 1: Measuring Performance
Insert reference in APA formatting, 6th ed. 4th printing
Research Topic
The topic is a broad subject. The topic is not the problem to be solved; that comes later. Example: Balanced Scorecard
Problem or Opportunity
The problem is established with factual data and is found in the introductory portion of the research article or report.
Purpose for the Research
The purpose of the study defines what the researcher wants to find out and is found in the introductory section of the research article. Sometimes the purpose contains a research question/s.
Research Methods
A researcher makes a decision about the broad nature of a research approach: typically quantitative/confirmatory or qualitative/exploratory. Research design strategies are driven by the chosen research approach and the research purpose. Research design strategies include: types of data collected, how the data is collected, and what preparation of data is used, analytical techniques, and presentation of information.
Audience
The groups, associates, profession, and/or individuals that the researcher suggests might benefit from the findings of this study
Research Evaluation
Assess the study’s Research Methods and Analytic Techniques. Are the research methods and analytic techniques applicable to solving practical management questions? Why or why not? You must substantiate your position with credible resources and examples.
Discuss how your organization might or might not use the findings from these studies. Substantiate your opinion with concrete examples.
Article 2: Incremental Analysis
Insert reference in APA formatting, 6th ed. 4th printing
Research Topic
The topic is a broad subject. The topic is not the problem to be solved; that comes later. Example: Cost Behavior
Problem or Opportunity
The problem is established with factual data and is found in the introductory portion of the research article or report.
Purpose for the Research
The purpose of the study defines what the researcher wants to find out and is found in the introductory section of the research article. Sometimes the purpose contains a research question/s.
Research Methods
A researcher makes a decision about the broad nature of a research approach: typically quantitative/confirmatory or qualitative/exploratory. Research design strategies are driven by the chosen research approach and the research purpose. Research design strategies include: types of data collected, how the data is collected, and what preparation of data is used, analytical techniques, and presentation of information.
Audience
The groups, associates, profession, and/or individuals that the researcher suggests might benefit from the findings of this study
Research Evaluation
Assess the study’s Research Methods and Analytic Techniques. Are the methods and analytic techniques applicable to solving practical management questions? Why or why not? You must substantiate your position wit.
Newark Analysis of a Pertinent Healthcare Issue HW.docx
HCFOFindingsBriefMarch2014FINAL
1. Overview
Health care payment reform is becoming
one of the most important issues debated by
health care policymakers, payers, providers,
and purchasers. Architects of new payment
models point out that the traditional fee-
for-service model encourages unnecessary
medications and procedures while capitation
promotes limits on care and poses financial
challenges to smaller provider groups.
During the late 1990s and early 2000s, pay-
for-performance (P4P) programs grew in
popularity. By design, P4P incorporates
rewards for providing guideline-based services
that mitigate the tendency toward underuse
inherent in capitation and discourage fee-for-
service–type overuse of expensive services—
for example, through incentives for generic
drug prescribing and appropriate use of
antibiotics and asthma controller medications.
In a HCFO-funded study, Douglas A.
Conrad, Ph.D., of the University of
Washington School of Public Health and
Community Medicine and colleagues
examined a unique quasi-experiment that
measured the effects of a large-scale P4P
program implemented by a leading health
insurer in Washington State between 2003
and 2007.1
In its phased experiment, the
plan recruited medical group practices and
restricted the program to the products
offered by commercial preferred provider
organization plans. The researchers examined
the clinical quality performance of three sets
of medical groups: (1) those participating
only in a quality scorecard (QSC) and public
reporting program, (2) those participating in
a quality incentives program (QIP) comprised
of P4P payments in addition to the quality
scorecard and reporting, and (3) a “control”
group of roughly comparable practice
organizations not participating in either the
QSC or QIP program.
Experiment
Using a phased approach to conduct the
experiment, the health plan first designed
a quality scorecard that it pretested with an
initial cohort between July 2001 and June
2002. Three medical groups started using
the scorecard in 2002, and four additional
groups began using it between 2003 and
2007. The initial three groups became eligible
The Challenges in Achieving Successful P4P Programs
Vol. XLII, No. 2
March 2014
Changes in Health Care Financing & Organization (HCFO)
key findings
• Study results indicate that neither
the quality scorecard nor the quality
incentive payment program had a
significant positive effect on general
clinical quality.
• Three main factors likely combined to
weaken program effects: (1) modest size
of the incentive; (2) use of rewards only;
(3) targeting incentive payments to the
group rather than to individuals.
• The researchers found that, relative
to the scorecard and reporting alone,
the addition of the Quality Incentive
Payment Structure (QIP) was associated
with a reduction in quality, a result
contrary to the intent of the payment
incentive program.
findings brief
Changes in Health Care Financing and Organization is a
national program of the Robert Wood Johnson Foundation
administered by AcademyHealth.
2. for incentive payments starting in 2004,
and the remaining four groups began
participating in the QIP between 2004 and
2007. The health plan did not randomly
select medical groups for the experiment
but instead targeted a specific set of large
medical groups for participation.
The medical leaders of the health plan
selected a set of well-established metrics
for the quality scorecard and provider
incentive payment program:
• Breast cancer screening (mammogram)
for women age 52-69 in the year prior
to or during the measurement year.
• Cervical cancer screening (Pap test) for
women age 21-64 in the 2 years prior to
or during the measurement year.
• Well-child visits: 6 or more by age
15 months.
• Use of optimal medications for asthma:
ages 5-56.
• Diabetes: 2 Hemoglobin A1c (HbA1c)
tests during the measurement year.
• Diabetes: ACE-Inhibitor or ARB
medication prescribed during the
measurement year.
• Coronary artery disease: LDL screening
during the measurement year.
The health plan structured the quality
payment incentive on points for each
measure. It incorporated both the level of
achievement and degree of improvement
from the previous year. During the
first two years of the experiment (2003
and 2004), only the highest-scoring
groups received incentive payments.
This “contest” resulted in payments
based on the relative performance of the
participating groups. During the second
two years of the experiment (2004 and
2005), incentive payments were based
on how closely the medical groups came
to reaching the achievable benchmarks
of care and the extent of performance
improvement over the previous year. The
groups bore no risk. Rather, incentive
payments were “new money.”
Analysis
Given the phased implementation of
the QSC and QIP components, the
researchers used a modified difference-in-
differences methodology. They compared
the seven intervention groups with five
comparison groups (the control group),
which were selected in collaboration
with the health plan. Most of the groups
in each cohort were physician-owned.
Given the plan’s structured approach to
soliciting medical groups, the researchers
used methods that mitigated potential
selection bias but noted that they could
not completely rule out factors that might
confound their estimates.
The researchers developed and used a
regression model to estimate the effects
on quality of two health plan quality
programs: the QIP and QSC. They
included patient-level variables to control
for factors that could affect providers’
quality achievement scores.
Results
To detect differential patterns in quality
performance over time, the researchers
constructed a time-series plot for each
quality measure. They distinguished
among three cohorts: (1) Ever QSC only,
(2) Ever QSC/QIP, (3) and the control
medical groups.
In general, the researchers did not find
marked differential changes over time
among cohorts on the quality indicators,
although they observed some baseline
differences including breast cancer
screening levels.
Both the scorecard and incentive program
cohorts showed considerably greater
achievement over time in LDL cholesterol
screening among diabetes patients within
the intervention groups than within
the controls. The intervention cohort
also showed some quality performance
improvement in ACE-inhibitor use
among diabetics. The researchers noted
that because both intervention cohorts
started lower at baseline, they had more
room for improvement. Overall, the
descriptive time series plots analyzed by
the researchers failed to reveal any added
benefit of program participation beyond
sentinel effects.
In their analysis of the effect of the
payment incentives on the quality
measures, the researchers found that
neither the scorecard and reporting alone
nor the QIP incentive had a positive
effect on quality. The analysis of the plan’s
experiment revealed results that were
opposite to the intent of the payment
incentive program.
Discussion and Policy
Implications
In considering their null findings,
the researchers pointed to several
observations, some of which were
drawn from key informant interviews.
They noted that the modest size of
the incentive payment likely played a
role in the results. However, the study
did not indicate a “treating to the test”
phenomenon associated with targeting
certain measures; the non-incentivized
services did not appear to be negatively
affected. The concentration on patients
from one health plan could have limited
the success of the experiment, although
studies in California have shown similar
results with multi-payer experiments.
Some physician interviewees noted that
the production-based incentives were not
aligned with the goal of the payments to
improve quality. Physicians also felt that
a significant drawback of the experiment
was the group rather than individual
nature of the incentive program.
The researchers made additional
observations. The health plan structured
the experiment to transition from a
relative performance model to an absolute
performance standard. There was no
evidence to show this shift generated
positive results, possibly due to the lack
of any downside risk. Yet, while penalties
may have been a stronger motivation to
perform, this structure would need to be
weighed against the negative reactions to
reducing a physician’s income.
findings brief — Changes in Health Care Financing & Organization (HCFO) page 2
3. This study offers five major contributions
to the larger body of literature on P4P:
(1) The results of this study support
other research showing that P4P has a
very small impact on quality. (2) This is
the first P4P study to contrast the effects
of quality incentives based on relative
performance versus absolute performance
based on achievable benchmark standards
within the same study sample. (3)
The phased-in nature of the publicly
reported quality scorecard, followed by
implementation of the quality incentive
program, allows one to separate the
effects of the scorecard from those of the
scorecard plus explicit quality incentives.
(4) The study combines key informant
interview data with the quantitative results
to provide a richer interpretation of the
findings. (5) This research is also one of
the few P4P studies to explicitly control
for case mix differences.
Conclusion
Given the modest success of many P4P
studies, it seems that other means of
controlling costs and increasing quality
should be explored. The researchers call
for “a full-court press on quality and
efficiency, based on common and broadly
defined clinical and economic metrics
among multiple payers and providers.”
For more information
Contact Douglas A. Conrad, Ph.D., at
dconrad@u.washington.edu.
About the author
Emily Blecker, B.A., is a research assistant at
AcademyHealth with the Changes in Health
Care Financing and Organization (HCFO)
initiative. She may be reached at 202-292-
6736 or at emily.blecker@academyhealth.org.
Endnotes
1. For complete findings, see Conrad, D.A.,
Grembowski, D., Perry, L., Maynard, C., Rodriguez,
H., and Martin, D., Paying physician group practices
for quality: A statewide quasi-experiment, Healthcare,
Vol. 1, No. 3-4, 2013, pp 108-116.
findings brief — Changes in Health Care Financing & Organization (HCFO) page 3