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Health Care Payment Approaches

Journal Article

Pay for Performance in the Hospital Setting: What Is the State of the Evidence?

More than 40 private sector hospital pay-for-performance (P4P) programs now exist, and Congress is considering initiating a Medicare hospital P4P program. Given the growing interest in hospital P4P, this systematic review of the literature examines the current state of knowledge about the effect of P4P on clinical process measures, patient outcomes and experience, safety, and resource utilization.

Jan 15, 2009
Journal Article

Healthcare Costs Associated with Depression in Medically Ill Fee-for-Service Medicare Participants

Examine the association between depression and healthcare costs in medically ill fee-for-service (FFS) Medicare recipients.

Jan 1, 2009
Journal Article

Quality Assessments By Sick and Healthy Beneficiaries in Traditional Medicare and Medicare Managed Care

The Centers for Medicare and Medicaid Services pays for services provided through traditional fee-for-service (FFS) Medicare and managed care plans (Medicare Advantage [MA]). It is important to understand how financing and organizational arrangements relate to quality of care. Compares care experiences and preventive services receipt in traditional Medicare and MA for healthy and sick beneficiaries.

Jan 1, 2009
Journal Article

Competition and the Mental Health System

This article describes three notable features of the competitive mental health care market and their policy implications.

Jan 1, 2009
Report

California's Workers' Compensation Program Could Model Pay-for-Performance

California's workers' compensation group health program is suitable for three models of a pay-for-performance initiative that include agreed on performance measures, expandable data-collection infrastructure, and incentives in order to ensure physician buy-in.

Jul 1, 2008
Journal Article

Falling Short: Continued Challenges in Meeting the Mental Health Needs of Children with Special Health Care Needs

High levels of unmet need persist for children with special health care needs in the face of substantial resources that have been committed to improving their care, including the integration of behavioral health into Medicaid managed care.

Jun 1, 2008
Journal Article

Nonprice Competition and Quality of Care in Managed Care: The New York SCHIP Market

Finds a negative association between nonprice competition and quality of care in managed care plans in the New York SCHIP market. Pricing policy is likely a constraint on quality production, though it may not be interpreted as a causal relationship.

Jun 1, 2008
Journal Article

Language and Regional Differences in Evaluations of Medicare Managed Care by Hispanics

Uses the Consumer Assessments of Healthcare Providers and Systems survey to examine the experiences of Hispanics enrolled in Medicare managed care. Hispanics face barriers to care; however, their experiences with care vary by language and region.

Apr 1, 2008
Journal Article

Pay for Performance in Behavioral Health

Presents the results of a targeted national effort to identify pay-for-performance programs in behavioral health. Many programs struggled to obtain accurate data on quality and outcomes of care, and public reporting of results was not widespread.

Jan 1, 2008
Journal Article

Clinician- and Organization-Level Factors in the Adoption of Evidence-Based Care for Depression in Primary Care

Barriers and propensity interact in affecting depression services. High-propensity clinicians are more likely to offer antidepressants in practices with more barriers.

Jan 1, 2008
Journal Article

Financial Incentives for Quality in Breast Cancer Care

Most breast cancer care providers in Los Angeles County outside of staff- or group-model HMOs are not subject to explicit financial incentives based on quality-of-care measures. New approaches are needed to direct incentives toward these specialists.

Jan 1, 2008
Journal Article

Survey Response Style and Differential Use of CAHPS Rating Scales by Hispanics

Hispanics report health care that is similar to or less positive than for non-Hispanic whites, yet have more positive ratings of care. Higher Hispanic ratings may be partially attributed to differences in response style rather than superior care.

Jan 1, 2008
Journal Article

Medicare HMO Impact on Utilization at the End of Life

Medicare beneficiaries who died while enrolled in independent practice association model HMOs, including the Kaiser model, had many fewer hospital days during the two years before death than beneficiaries who died with fee-for-service coverage.

Jan 1, 2008
Journal Article

Medicare Capitation Model, Functional Status, and Multiple Comorbidities: Model Accuracy

Examines financial implications of the Centers for Medicare & Medicaid Services Hierarchical Condition Categories risk-adjustment model on Medicare payments for individuals with comorbid chronic conditions. Some payments were underpredicted.

Jan 1, 2008
Brochure

Policy Insight, Volume 1, Issue 6, December 2007: Pay for Performance

This Policy Insight examines the pros and cons of explicit pay-for-performance schemes for federal civil servants compared with seniority-based salary systems, as well as the proposals to change the General Schedule system.

Dec 8, 2007
Journal Article

Mental Health and Substance Abuse Insurance Parity for Federal Employees: How Did Health Plans Respond?

The intent of parity regulation is to equalize private insurance coverage for mental and physical illness (an equity concern) and to eliminate wasteful forms of competition due to adverse selection (an efficiency concern). In 2001, a presidential directive requiring comprehensive parity was implemented in the Federal Employees Health Benefits (FEHB) Program. In this study, the authors examine how health plans responded to the parity directive.

Dec 4, 2007
Journal Article

Insurers' Competitive Strategy and Enrollment in Newly Offered Preferred Provider Organizations (PPOs)

While early growth in preferred provider organizations (PPOs) coincided with growth of managed care generally, recent expansion has come primarily at the expense of other managed care plans.

Dec 1, 2007
News Release

RAND and Health Dialog to Create New Tools to Evaluate Quality and Efficiency of Health Care

The RAND Corporation and Health Dialog Services Corporation announced an alliance that will entitle Health Dialog to exclusive, worldwide rights to integrate select RAND quality measures into its existing provider performance measurement tools and care management services.

Aug 6, 2007
Journal Article

The Response of Physician Groups to P4P Incentives

The authors found an association between P4P incentives and the use of quality improvement initiatives.

May 1, 2007
Journal Article

Hospital Competition, Managed Care, and Mortality After Hospitalization for Medical Conditions in California

Assesses the effect of hospital competition and HMO penetration on mortality after hospitalization for six medical conditions in California.

Apr 1, 2007

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