Pay for Performance in Medicaid: Evidence from the Field

描述（由申请人提供）：尽管支出水平很高，但美国的医疗保健质量并不理想，这一认识导致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经济激励。最近的研究表明，医疗补助计划同样越来越多地参与所谓的“按业绩付费”，目标是管理式医疗计划和提供者。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，独立并与私营部门合作，坚持以价值为基础的采购原则。尽管有这种趋势，而且更多的美国人通过医疗补助计划获得保险，而不是任何其他单一计划，但除了一些小实验外，关于医疗补助计划中按绩效付费的影响的研究在很大程度上没有出现在研究领域。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，关于按业绩付费的经验教训可能不会轻易转移。特别是，对绩效衡量和绩效支付对面临更大健康风险、病情更重、更频繁残疾、可能更难坚持的患者获得护理的影响的担忧，在弱势医疗补助人群的背景下尤其引起共鸣。该项目旨在通过评估三个州的医疗补助机构采用的原型计划，并通过进行调查以确定这些计划对服务于相对较大比例的医疗补助患者的医生（“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影响的证据基础。通过定性和定量相结合的方法，该研究将研究在不同的市场和战略中，医疗补助中按绩效付费的风险和好处。该项目的最终目标是在医疗补助计划中增加采用有效的绩效工资和相关的基于价值的采购工作。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，并确保研究从其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.