Data and Outcomes - State

 

Limited articles added at this time.

Articles by State:

Multiple State Studies: 374, 407 

Ohio: 364

 

State Data and Outcomes Literature

Multiple State Studies

Key Article

(374) Rosenthal et al. Pay for Performance in Medicaid: Evidence from Three Natural Experiments. Health Serv Res. 2015 Dec 27. doi: 10.1111/1475-6773.12426. [Epub ahead of print]

PMID: 26708000

Summary:

  • Examination of the P4P effect on quality and utilization of care in Medicaid between P4P intervention states (Pennsylvania, Minnesota, and Alabama) and three comparison states (Florida, Wisconsin, Georgia)
  • All three programs focused on physician incentives as opposed to hospitals or managed care organizations, but each utilized a distinct model of incentives:
  • Medical home structural incentive and shared savings model (Alabama)
  • Diabetes program which rewards providers based on an “all-or-none” measure and payment for intermediate health outcomes as opposed to solely process measures (Minnesota)
  • Rewarding collaboration for disease management of chronically ill patients based on process measures (Pennsylvania)
  • Results were as follows:
    • Reduction of ambulatory visits in Pennsylvania compared with Florida
    • Decrease in hospital admissions in Minnesota compared to Wisconsin
    • Slight decline in hospital admissions but an increase in ambulatory visits in Alabama compared to Georgia
    • Little improvement in process quality measures, and modest reductions in inpatient use in Minnesota and Alabama

Significance to Literature:

There was no evidence for more quality improvement In States with P4P Medicaid programs as compared to matched States with no P4P Medicaid programs. However, a limitation we noted (as authors of this website and professionals in Minnesota) was that the Minnesota/Wisconsin comparison used percentage of diabetics receiving A1c and LDL tests, whereas Minnesota’s P4P program rewarded for A1c outcome <7 and LDL <100.  

There were significant changes in utilization patterns.

States on the forefront of P4P implementation should inform future program design as more states move to performance and quality-based payment.

 

(407) Hu T, Decker SL, Chou SY. Medicaid Pay for Performance Programs and Childhood Immunization Status. Am J Prev Med. 2016 May;50(5 Suppl 1):S51-7. doi: 10.1016/j.amepre.2016.01.012

PMID: 27102859

Summary:

  • Study examines the effects of state Medicaid P4P programs adopted in 19 states on childhood immunization rates
  • Data from the 1999-2011 National Immunization Survey and state P4P program information from CMS in children aged 19-35 months was used to determine if immunization rates were higher in states that adopted Medicaid P4P programs
  • Overall, state Medicaid P4P programs had no effect on the chances a child aged 19-35 months completed the 4:3:1:3:3:1 vaccination series
  • 4% increase in the likelihood a child aged 19-23 months completed the vaccination series

Significance to Literature:

Modest evidence that state Medicaid P4P programs can help improve childhood vaccination rates

 

Ohio

(364) Gleeson S, Kelleher K, Gardner W. Evaluating a Pay-for-Performance Program for Medicaid Children in an Accountable Care Organization. JAMA Pediatr. 2016 Mar 1;170(3):259-66. doi: 10.1001/jamapediatrics.2015.3809.

PMID: 26810378

Summary:

  • Retrospective cohort study conducted from January 1, 2010 to December 31, 2013 to determine if P4P improved physician performance within the context of a pediatric accountable care organization (ACO) serving Medicaid children in Ohio
  • Physicians were divided into three groups:
    • Community physicians who received P4P incentives
    • Non-incentivized community physicians
    • Non-incentivized hospital physicians
  • Among the 21 quality measures (14 subject to incentives) examined, incentivized community physicians showed greater performance improvement than non-incentivized community physicians in 5 incentivized and 2 non-incentivized measures
  • Hospital non-incentivized physicians had greater performance improvements on 8/14 incentivized measures and 1/7 non-incentivized measures

Significance to Literature:

P4P alone in a pediatric ACO appears to result in modest performance improvement, but “other interventions at the disposal of the ACO may have been more effective.”