Pay for Performance in Medicaid: Evidence from the Field

描述（由申请人提供）：尽管美国的医疗保健支出水平很高，但由于认识到美国的医疗保健质量不是最理想的，许多私人保险公司和健康福利购买者采取措施，为质量改进和成本效益创造财政激励。最近的研究表明，医疗补助计划同样也越来越多地涉及所谓的“绩效薪酬”，目标是管理医疗计划和提供者。此外，医疗保险和医疗补助服务中心以及其他利益相关者都呼吁医疗补助机构加快努力，独立地坚持以价值为基础的采购原则，并与私营部门合作。尽管有这种趋势，而且事实上，通过医疗补助计划获得保险的美国人比其他任何单一计划都多，但除了一些小型实验外，研究领域基本上没有对医疗补助计划中绩效薪酬影响的研究。此外，医疗补助的独特人口、提供者基础和融资表明，在商业保险或医疗保险的背景下，根据绩效支付的经验教训可能不容易转移。特别是，对于面临更大健康风险、病情更重、更经常残疾、可能在坚持治疗方面有更大困难的患者，绩效衡量和按绩效付费对其获得护理的影响的关切，在医疗补助弱势群体的背景下尤其能引起共鸣。本项目旨在通过评估三个州的医疗补助机构采用的原型项目，并通过进行一项调查，以确定这些项目对为相对较大比例的医疗补助患者服务的医生（“以医疗补助为重点的医生”）的看法和影响，来增加医疗补助中绩效薪酬的实施和效果的证据基础。通过定性和定量相结合的方法，该研究将在不同的市场和战略中检查医疗补助中按绩效支付的风险和收益。该项目的最终目标是在医疗补助中增加有效绩效薪酬和相关的基于价值的采购工作的采用。为了增加研究的相关性，将召集一个咨询小组来确定医疗补助官员的关注点，并确保研究从主要受众的角度解决最重要的问题。

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.