Pay for Performance in Medicaid: Evidence from Three Natural Experiments
Pay for Performance in Medicaid: Evidence from Three Natural Experiments
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DOI：
10.1111/1475-6773.12426
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发表时间：
2016-08-01
影响因子：
3.4
通讯作者：
Schneider, Eric C.
中科院分区：
文献类型：
--
作者：
Rosenthal, Meredith B.;Landrum, Mary Beth;Schneider, Eric C.
Objective.研究医疗补助中按绩效付费对护理质量和利用率的影响。数据来源。三个干预州（宾夕法尼亚州、明尼苏达州和亚拉巴马州）和三个比较州的医疗补助索赔和就诊数据。倾向评分匹配对照组的差异中差异分析。感兴趣的主要结果是医疗保健效果数据和信息集（HEDIS）的质量，利用服务类别，门诊护理敏感的入院和急诊科就诊的过程中的措施。在宾夕法尼亚州，与佛罗里达州相比，每1,000名登记者每月有88次门诊就诊，这在统计学上显著减少。在明尼苏达州，与威斯康星州相比，每千名登记者月的住院人数显著减少了7.2人。在亚拉巴马州，奖励措施直到2年豁免期结束后才发放，与格鲁吉亚州相比，每1,000名注册者的住院率下降了1.6人，每1,000名注册者的门诊率增加了59人。相对于控制状态，干预没有显着的质量改善。我们的调查结果喜忧参半，三个州没有可衡量的质量改善，但两个项目的住院人数减少了。随着各州转向以病人为中心的医疗之家和负责任的护理组织的价值为基础的支付，从这些开创性的州吸取的经验教训应该为项目设计提供信息。
Objective. To examine the impact of pay for performance in Medicaid on the quality and utilization of care.Data Sources. Medicaid claims and encounter data in three intervention states (Pennsylvania, Minnesota, and Alabama) and three comparison states.Study Design. Difference-in-difference analysis with propensity score-matched comparison group. Primary outcomes of interest were Healthcare Effectiveness Data and Information Set (HEDIS)-like process measures of quality, utilization by service category, and ambulatory care-sensitive admissions and emergency department visits.Principal Findings. In Pennsylvania, there was a statistically significant reduction of 88 ambulatory visits per 1,000 enrollee months compared with Florida. In Minnesota, there was a significant decrease of 7.2 hospital admissions per thousand enrollee months compared with Wisconsin. In Alabama, where incentives were not paid out until the end of a 2-year waiver period, there was a decline of 1.6 hospital admissions per thousand member months, and an increase of 59 ambulatory visits per 1,000 enrollees compared with Georgia. No significant quality improvements in intervention relative to control states.Conclusions. Our findings are mixed, with no measurable quality improvements across the three states, but reductions in hospital admissions in two programs. As states move to value-based payment for patient-centered medical homes and Accountable Care Organizations, lessons learned from these pioneering states should inform program design.