Pay for Performance in Medicaid: Evidence from the Field

医疗补助中的绩效薪酬：来自现场的证据

• 批准号: 8037720
• 负责人: MEREDITH B. ROSENTHAL
• 金额: $ 28.94万
• 依托单位: HARVARD SCHOOL OF PUBLIC HEALTH
• 依托单位国家: 美国
• 财政年份: 2009
• 资助国家: 美国
• 起止时间: 2009-03-01 至 2013-02-28
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8037720
• 关键词: Pay; Performance; Medicaid; Evidence; Field

DESCRIPTION (provided by applicant): The recognition that health care quality in the U.S. is suboptimal despite the high level of spending has led many private insurers and health benefit purchasers to take steps to create financial incentives for quality improvement and cost-efficiency. Recent studies suggest that Medicaid programs likewise are increasingly becoming engaged in so-called "pay for performance" targeting both managed care plans and providers. Moreover, both the Centers for Medicare and Medicaid Services and other stakeholders have called for Medicaid agencies to accelerate efforts to adhere to the tenets of value-based purchasing independently and in collaboration with the private sector. Despite this trend and the fact that more Americans receive insurance coverage through Medicaid than any other single program, studies of the impact of pay for performance in Medicaid are largely absent from the research landscape, with the exception of a few small experiments. Furthermore, Medicaid's unique population, provider base, and financing suggest that lessons learned about pay for performance in the context of commercial insurance or Medicare may not transfer easily. In particular, concerns about the effects of performance measurement and pay for performance on access to care for patients who face greater health risks, are sicker, more frequently disabled, and may have greater difficulty with adherence are particularly resonant in the context of the vulnerable Medicaid population. This project seeks to increase the evidence base around the implementation and effects of pay for performance in Medicaid by evaluating prototypical programs adopted by Medicaid agencies in three states and by conducting a survey to ascertain perception of and effects of these programs on physicians that serve relatively large proportions of Medicaid patients ("Medicaid-focused physicians"). Through a combined qualitative and quantitative approach the study will examine the risks and benefits of pay for performance in Medicaid across a diverse set of markets and strategies. The ultimate objective of the project is to increase the adoption of effective pay for performance and related value-based purchasing efforts in Medicaid. To increase the relevance of the research, an Advisory Panel will be convened to identify the concerns of Medicaid officials and ensure that the research addresses the most important questions from the perspective of its principal audience.

描述(由申请人提供)：人们认识到，尽管支出水平很高，但美国的医疗保健质量并不理想，这导致许多私营保险公司和健康福利购买者采取措施，为提高质量和成本效益创造财政激励措施。最近的研究表明，医疗补助计划同样越来越多地参与到针对管理型医疗计划和提供者的所谓“按绩效付费”中。此外，医疗保险和医疗补助服务中心以及其他利益攸关方都呼吁医疗补助机构加快努力，独立并与私营部门合作，坚持基于价值的采购原则。尽管有这种趋势，而且通过医疗补助获得保险的美国人比其他任何单一计划都多，但除了几个小实验外，关于医疗补助绩效工资影响的研究基本上没有。此外，医疗补助独特的人群、提供者基础和资金来源表明，在商业保险或医疗保险背景下学到的按绩效支付的经验教训可能不会轻易转移。特别是，对绩效衡量和绩效工资对获得护理的影响的担忧在弱势医疗补助人群中尤其引起共鸣，这些患者面临更大的健康风险，病情更重，残疾更多，遵守起来可能更困难。该项目旨在通过评估三个州的医疗补助机构采用的典型计划，并进行一项调查，以确定这些计划对为相对较大比例的医疗补助患者提供服务的医生(“以医疗补助为重点的医生”)的看法和影响，从而增加关于医疗补助计划的实施和效果的证据基础。通过定性和定量相结合的方法，这项研究将在一系列不同的市场和战略中审查按绩效支付医疗补助的风险和好处。该项目的最终目标是在医疗补助中更多地采用有效的绩效工资和相关的基于价值的购买努力。为了提高研究的相关性，将召集一个咨询小组，以确定医疗补助官员的关切，并确保研究从主要受众的角度解决最重要的问题。