New Approach to Quality-Based Incentives Avoids Undesired Effects on Health Care Providers Who Care for Disadvantaged Patients
Jan 14, 2015
Broader use of case-mix-adjustment of provider performance could improve measurement but won't eliminate lower average payments to providers serving disadvantaged patients. Payments could be post-adjusted according to provider categories defined by characteristics of the patient population, strengthening incentives among lower performers.
Published in: Health Affairs, v. 34, no. 1, Jan. 2015, p. 134-142
Posted on RAND.org on January 09, 2015
Providers that care for disproportionate numbers of disadvantaged patients tend to perform less well than other providers on quality measures commonly used in pay-for-performance programs. This can lead to the undesired effect of redistributing resources away from providers that most need them to improve care. We present a new pay-for-performance scheme that retains the motivational aspects of standard incentive designs while avoiding undesired effects. We tested an alternative incentive payment approach that started with a standard incentive payment allocation but then "post-adjusted" provider payments using predefined patient or provider characteristics. We evaluated whether such an approach would mitigate the negative effects of redistributions of payments across provider organizations in California with disparate patient populations. The post-adjustment approach nearly doubled payments to disadvantaged provider organizations and greatly reduced payment differentials across provider organizations according to patients' income, race/ethnicity, and region. The post-adjustment of payments could be a useful supplement to paying for improvement, aligning the goals of disparity reduction and quality improvement.