Incorporating Disparity Reduction into Pay-for-Performance

Filling the Gaps between Performance Incentive Programs and Health Care Quality Improvement

“…Key proposals to address these issues include the recent development of quality measures that are intended to directly target disparity reduction, along with the design of some P4P programs to reward quality improvement in addition to the achievement of high benchmark levels of quality (Casalino et al 2007; Chien and Chin 2009). Here, we highlight pressing gaps in the literature and propose a set of priorities for health services researchers to advance the field of quality measurement and facilitate development of more comprehensive and effective performance incentive programs.…”

Creating the Business Case for Achieving Health Equity

“…However, if we fail to address payment reform to achieve equity, then we have missed a crucial opportunity, as carefully designed incentives may have tremendous potential to reduce disparities when combined with other interventions. 4,[7][8][9][10][11] Care transformation and disparities reduction are challenging, and become higher strategic priorities for an organization when its economic margin depends upon success in these areas. Therefore, this paper focuses on six ways that CMS and private payors can align financial and non-financial incentives to achieve health equity (Table 1).…”

“…18,19 Third, CMS and private payors need to explicitly incentivize the reduction of health disparities as they design payment systems and choose and implement clinical performance measures. 8,9 Too often, CMS, private payors, and the quality improvement field have adopted a Brising tide lifts all boatsp hilosophy, hoping that efforts to improve quality of care generally will reduce disparities. The National Healthcare Quality and Disparities Report and local data suggest that generic initiatives to improve quality of care do not necessarily reduce disparities and can increase disparities.…”

“…23 CMS should provide technical assistance and financial support to resourcepoor safety-net organizations to improve their quality of care, so that they are competitive in pay-forperformance programs. 8,10,24 In addition, cuts enacted by the Affordable Care Act to Disproportionate Share Hospital (DSH) payments, the program that has aided hospitals that care for large numbers of uninsured patients, should be calibrated to the pace of health insurance expansion and/or offset by other funding to safetynet hospitals, because many patients remain uninsured, Medicaid payments are low, and medical inflation outpaces payment. 25 Safety-net hospitals in states that have not expanded Medicaid eligibility are at particularly high financial risk.…”

“…For example, what are the most effective equity clinical performance measures (e.g., reward improvement, attainment of absolute thresholds of quality, or combinations)? 4,8,24 Can structural requirements of the culturally competent, equitable health care organization be linked to reimbursement (e.g., good access to professional medical interpreters)? 7 What combination of adjusting for the sociodemographic and clinical case-mix of patients, and stratified comparisons of care are most effective in improving quality of care and reducing disparities?…”