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Health Care Pay for Performance

"Pay for performance" rewards doctors, hospitals, and other health care providers for attaining targeted service goals, like meeting health care quality or efficiency standards. RAND research has explored a range of policy and economic implications related to the use of pay-for-performance delivery models.

Testimony

Improving Care for Medicare Beneficiaries with Physician Payment Reform

Physician payment policy is shifting from one that incentivizes the delivery of more services without regard to quality or outcomes to one that incentivizes the delivery of high quality, resource conscious health care. Thoughtful incentive design can ease the transition process for both physicians and the Medicare program.

Jun 5, 2013
Testimony

Efforts to Reform Physician Payment by Tying Payment to Performance

Public and private sector purchasers are actively working to design value-based payment programs to achieve the goals of improved quality and more efficient use of health care resources. How these programs are designed is a complex undertaking and one that will determine the likelihood of their success.

Feb 14, 2013
Journal Article

Design and Use of Performance Measures to Decrease Low-Value Services and Achieve Cost-Conscious Care

The American College of Physicians recently launched its High-Value Care Initiative to help physicians and patients understand the benefits, harms, and costs of interventions and to determine whether services provide good value.

Jan 1, 2013
Journal Article

How Well Do Medicare's Pay-for-Performance (P4P) Programs Match Desirable P4P Design Criteria?

Alignment with best P4P practices varies across Medicare programs; the program for Medicare Advantage aligns most strongly. It is unclear which P4P design elements are critical for quality improvement. Unintended consequences of design features are poorly understood.

Jan 1, 2013
Journal Article

Do Physician Organizations Located in Lower Socioeconomic Status Areas Score Lower on Pay-for-Performance Measures?

Physician organizations (POs)—independent practice associations and medical groups—located in lower socioeconomic status (SES) areas may score poorly in pay-for-performance (P4P) programs.

May 1, 2012
Journal Article

Ways to Improve Health Care Provider 'Report Cards'

As health care reform expands the use of "report cards" to grade health care providers, greater attention to reporting methods may be needed to assure the quality of such efforts.

Mar 1, 2012
Journal Article

Pay-for-performance Programs to Reduce Racial/Ethnic Disparities: What Might Different Designs Achieve?

Pay-for-performance (P4P) programs may have unintended effects on racial/ethnic disparities.

Feb 1, 2012
Journal Article

Bundling Payments to Curb Health Care Costs Proves Difficult to Realize

Under bundled payments, doctors, hospitals, and other providers share one fee for treating all aspects of a procedure such as a hip replacement or a chronic disease like diabetes. The approach should eliminate unnecessary care and improve quality, but putting it into practice is proving to be more difficult than anticipated.

Nov 1, 2011
Journal Article

Methodological Considerations in Generating Provider Performance Scores for Use in Public Reporting: A Guide for Community Quality Collaboratives

This white paper prepared for the Agency on Healthcare Research and Quality examines methodological issues raised by the generation of public-reporting of scores for measuring health care provider performance.

Sep 1, 2011
Report

Using Prizes to Support and Reward Excellence in Health Research

Research indicates that there is merit in developing incentives to support excellence in health research in addition to “standard” performance management and routine inspection in the United Kingdom.

Jun 28, 2011
Report

Paying for Quality in the German Healthcare System

Germany's National Association of Statutory Health Insurance Physicians is looking to develop a unified reimbursement framework that accounts for regional prices and incorporates quality indicators. Research by RAND Europe has informed the development of the quality component of the proposed framework.

Mar 22, 2011
News Release

Investment in New Health Care Quality Measures Needed as Cost-Cutting Strategies Grow

As the health care industry, employers, and government officials seek to control the growth of health spending, new efforts are needed to develop and refine quality-of-care and other performance measures that can assure changes will improve medical care and do not harm patients.

Feb 22, 2011
Report

Investment in New Health Care Quality Measures Needed as Cost-Cutting Strategies Grow

Health care spending reforms should be met with new efforts to develop and refine quality of care and other performance measures in order to assure that any changes will improve medical care and not harm patients.

Feb 22, 2011
Journal Article

Hospital Executives' Perspectives on Pay-for-Performance and Racial/Ethnic Disparities in Care

Hospitals executives hesitant about using pay-for-performance programs to reduce racial/ethnic disparities in care.

Oct 1, 2010
Research Brief

Are Performance-Based Accountability Systems Effective? Evidence from Five Sectors

Creating an effective Performance-Based Accountability System (PBAS) requires careful attention to selecting an appropriate design for the PBAS, given the context in which it is to operate, and to monitor, evaluate, and adjust the system, as appropriate.

Jul 28, 2010
Report

Performance-Based Accountability Systems for Public Services

Evidence supports continued experimentation with and adoption of performance-based accountability systems (PBAS) in various sectors: child care, education, health care, public health emergency preparedness, and transportation. However, PBAS design and its prospects for success depend on the context in which it will operate.

Jul 21, 2010
Report

Analyzing the Operation of Performance-Based Accountability Systems for Public Services

Empirical evidence of the effects of performance-based public management is scarce. But a framework for organizing the empirical information we do have could identify individuals or organizations that must change to improve performance, select an effective incentive structure, and choose performance measures that inform the incentive structure appropriately.

Jul 14, 2010
Journal Article

Using the Lessons of Behavioral Economics to Design More Effective Pay-for-Performance Programs

Although pay for performance incentives are increasingly popular, the healthcare literature shows that these have had minimal effect. Design improvements in these programs can enhance their effectiveness.

Jul 1, 2010
News Release

Performance-Based Payments for Primary Care Providers May Worsen Disparities in Medical Care

Rewarding primary care physicians for providing better care to patients could end up widening medical disparities experienced by poorer people and by minorities. Increasing the number of primary care physicians is also not enough to boost U.S. health care quality and lower costs.

May 4, 2010
Journal Article

Performance-Based Payments for Primary Care Providers May Worsen Disparities in Medical Care

Rewarding primary care physicians for providing better care to patients could end up widening medical disparities experienced by poorer people and by minorities. Increasing the number of primary care physicians is also not enough to boost U.S. health care quality and lower costs.

May 1, 2010

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RAND Topic:
Health Care Pay for Performance

Topic Synonyms:
P4P;
Value-Based Purchasing

Research conducted by

RAND Health Care