Taking Stock of Pay-for-Performance

A Candid Assessment from the Front Lines

Published In: Health Affairs, v. 28, no. 2, Mar./Apr. 2009, p. 517-525

Posted on RAND.org on March 15, 2009

by Cheryl L. Damberg, Kristiana Raube, Stephanie S. Teleki, Erin de la Cruz

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Pay-for-performance (P4P) has been widely adopted, but it remains unclear how providers are responding and whether results are meeting expectations. Physician organizations involved in the California Integrated Healthcare Association's (IHA) P4P program reported having increased physician-level performance feedback and accountability, speeded up information technology adoption, and sharpened their organizational focus and support for improvement in response to P4P; however, after three years of investment, these changes had not translated into breakthrough quality improvements. Continued monitoring is required to determine whether early investments made by physician organizations provide a basis for greater improvements in the future.

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