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Health Care Payment Approaches

Report
The Reliability of Provider Profiling: A Tutorial
Although hospitals and managed care facilities have used performance measurement for some time, the focus on doctor profiling by purchasers and health plans is relatively new, bringing to the fore the limitations of available physician data and proving the need for reliability measures in physician profiling.
Jun 25, 2009
Journal Article
Managed Care Quality of Care and Plan Choice in New York SCHIP
Examines whether low-income parents of children enrolled in the New York State Children's Health Insurance Program (SCHIP) choose managed care plans with better quality of care.
Jun 1, 2009
Journal Article
Who Gets Disease Management?
This was an observational study of the health care use, costs, and quality of care of 27,211 members of a large health insurer who were identified through claims as having asthma, diabetes, or congestive heart failure, were considered to be at high risk for incurring significant claims costs, and were eligible to join a disease management program involving health coaching. Findings illuminated the serious problem of selection into Disease management (DM) programs and suggest that the effectiveness levels found in prior evaluations using methodologies that don't address this may be overstated.
May 1, 2009
Commentary
Quality, Transparency, and the US Government
If the government is demanding transparency of physicians and hospitals, the very least the physicians and hospitals should do is demand transparency of the government, writes Robert Brook.
Apr 1, 2009
Research Brief
Designing Effective Pay-for-Performance in K-12 Education
RAND recommends policy actions and investments to increase the likelihood of success of pay-for-performance systems of educator compensation in the United States and identify the practices most likely to succeed.
Mar 26, 2009
Journal Article
Pay-For-Performance for Medical Groups Stimulates Changes in Practice
A large group of California physicians given financial incentives to improve the quality of medical care have begun to embrace an array of changes important to advancing quality.
Mar 15, 2009
News Release
Pay-For-Performance for Medical Groups Stimulates Changes in Practice
A large group of California physicians given financial incentives to improve the quality of medical care have begun to embrace an array of changes important to advancing quality.
Mar 11, 2009
Journal Article
Managed Care's Price Bargaining with Hospitals
Research has shown that managed care (MC) slowed the rate of growth in health care spending in the 1990s, primarily via lower unit prices paid.
Mar 1, 2009
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

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