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Welcome to the Pay-for-Performance Research Site 

This website, sponsored by the University of Minnesota Department of Family Medicine and Community health as well as Minnesota Academy of Family Physicians Foundation, is designed to help clinicians, educators, and students navigate the complex landscape of pay for performance (P4P). It contains over 400 references with summaries and links where available.

The site is organized by topics of interest along the toolbar at the top of the screen, so that users may go directly to a particular item as needed. At the top of each section is a summary of the topic with a list of relevant summarized articles to follow. The website is regularly updated with new topics and references from both Medline referenced sources and the popular press. 

This website, like P4P, is a dynamic process. As such, please feel free to use the contact information listed in the Authors section for any comments, suggestions, and additional references. 


How we recommend using the website:

  • Looking to get a general idea of what P4P is all about? See below for a definition and use the Overview page to get the basics of P4P
  • Curious about MACRA and MIPS? The National-CMS (MACRA) page under the Programs tab section looks to summarize the history and future of P4P within CMS
  • Wondering what goes into a successful P4P program? Click on the Program Design and Implementation page to review the extensive research on what makes an effective P4P scheme
  • Trying to figure out if P4P actually works? The Data and Outcomes section has some of the rapidly increasing research on the results of P4P programs, including specific pages for United States and International data
  • Hoping to catch up on the most recent impactful research on P4P? Go to the Key Articles to view papers the authors of this website believe to be most meaningful to the P4P landscape



P4P definition - What is P4P?

P4P has many definitions. As a result, P4P can mean different things to different people. At its core, P4P is a system of reimbursement that pays clinicians bonuses based on predetermined performance measures.


The goals of P4P are twofold:

  • P4P aims to improve the quality of care by incenting clinicians to focus on particular processes of care or to strive towards particular patient outcomes.
  • It is hoped that P4P will provide substantial cost savings, either indirectly (by keeping patients healthier) or directly (by incentivizing clinicians to provide more cost-effective care).


P4P is one of three increasingly common forms of performance-based incentives that are often used simultaneously. They include:

  • P4P using positive incentives (ex. a financial bonus) versus negative incentives (ex. financial withholds or non-payment).
  • Public Reporting or Report Cards – the performance results of clinics or individual clinicians.
  • Ranking or Tiering clinics or individual clinicians based on their performance and using the ranking to determine differential patient copays or network affiliations.


P4P programs for clinicians are currently offered by:

  • Insurers – including Medicare and Medicaid at the state and national levels
  • Health systems and HMOs
  • Community-based organizations (typically public reporting only)


Like all forms of physician reimbursement, P4P has benefits and burdens, which are reflected in an exponentially growing medical, economic, political, legal, and bioethical literature (See Controversial Issues section).