Pay for Performance in Health Care: Methods and Approaches

Abstract

This book provides a balanced assessment of pay for performance (P4P), addressing both its promise and its shortcomings. P4P programs have become widespread in health care in just the past decade and have generated a great deal of enthusiasm in health policy circles and among legislators, despite limited evidence of their effectiveness. On a positive note, this movement has developed and tested many new types of health care payment systems and has stimulated much new thinking about how to improve quality of care and reduce the costs of health care. The current interest in P4P echoes earlier enthusiasms in health policy—such as those for capitation and managed care in the 1990s—that failed to live up to their early promise. The fate of P4P is not yet certain, but we can learn a number of lessons from experiences with P4P to date, and ways to improve the designs of P4P programs are becoming apparent. We anticipate that a “second generation” of P4P programs can now be developed that can have greater impact and be better integrated with other interventions to improve the quality of care and reduce costs.

Expanding the breadth of Medicare: learning from Australia

“…The Practice Incentives Program introduced a pay-for-performance (P4P) element into primary medical care funding. More accurately described as 'pay for process adherence', as would be expected from the very mixed international evaluations of P4P (Tanenbaum, 2009;Cromwell et al, 2011;de Bruin et al, 2011;Eijkenaar, 2012;Eijkenaar et al, 2013), the Australian P4P experience in primary care is also mixed (Scott et al, 2009;Scott et al, 2011;Greene, 2013).…”

GPs and hospital expenditures. Should we keep expenditure containment programs alive?

“…In the British NHS, studies have focused on the UK's Quality and Outcomes Framework, in order to assess trends in quality indicators before and after the introduction of this program [see Campbell et al 2008, Gravelle, Sutton andMa 2010;Sutton et al 2010;Dusheiko et al, 2011]. Overall, such P4P programs have led to a broad debate over the impact of existing schemes and possible design improvements [Christianson et al, 2008;Nolan et al, 2011;Cromwell et al, 2011;Scott et al, 2011].…”

Respiratory Care Year in Review 2011: Long-Term Oxygen Therapy, Pulmonary Rehabilitation, Airway Management, Acute Lung Injury, Education, and Management

“…Notable pilots spawned by P4P include care management of high cost beneficiaries, cancer prevention and treatment, physician group practice, medical home, heart bypass, and heart and orthopedic centers of excellence. 115 In many instances the P4P results have not met projected outcomes, but the ACA will continue testing of current and future P4P pilots, with the goal of improving efficiency value. Challenges include alignment of providers, addressing those providers who serve a disproportionate share of the poor, and incentive programs that reward quality outcomes and cost-effectiveness, particularly in a broader scope than just the episode of acute care.…”