Paying for Performance

Implementing a Statewide Project in California

Published in: Quality Management in Health Care, v. 14, no. 2, Apr./June 2005, p. 66-79

Posted on on January 01, 2005

by Cheryl L. Damberg, Kristiana Raube, Thomas R. Williams, Stephen M. Shortell

Read More

Access further information on this document at

This article was published outside of RAND. The full text of the article can be found at the link above.

The US health care system falls far short of providing care consistent with national standards of care and available knowledge. In 2002, the Robert Wood Johnson Foundation (RWJ) and the California HealthCare Foundation (CHCF) funded 7 demonstration projects under the Rewarding Results program to implement and evaluate financial and nonfinancial incentives for quality. The largest is the Integrated Healthcare Association's (IHA) Pay for Performance (P4P) program, which currently covers over 6.5 million or close to one quarter of all Californians. This article describes the implementation of the IHA P4P program and explores the difficult decisions and collaborative structures that were created to make statewide P4P a reality in California. In contrast to several of the other Rewarding Results P4P demonstrations that involve only one health plan, this project is unique in that it involves multiple, competing commercial health plans in a large statewide initiative, thus representing the kind and scale of interorganizational coordination that may be needed to have substantial impact.

This report is part of the RAND Corporation External publication series. Many RAND studies are published in peer-reviewed scholarly journals, as chapters in commercial books, or as documents published by other organizations.

Our mission to help improve policy and decisionmaking through research and analysis is enabled through our core values of quality and objectivity and our unwavering commitment to the highest level of integrity and ethical behavior. To help ensure our research and analysis are rigorous, objective, and nonpartisan, we subject our research publications to a robust and exacting quality-assurance process; avoid both the appearance and reality of financial and other conflicts of interest through staff training, project screening, and a policy of mandatory disclosure; and pursue transparency in our research engagements through our commitment to the open publication of our research findings and recommendations, disclosure of the source of funding of published research, and policies to ensure intellectual independence. For more information, visit

The RAND Corporation is a nonprofit institution that helps improve policy and decisionmaking through research and analysis. RAND's publications do not necessarily reflect the opinions of its research clients and sponsors.