[Summary in Progress]

Pediatrics Literature

(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


  • 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.”


(452) Chien AT, Song Z, Chernew ME, et al. Two-Year Impact of the Alternative Quality Contract on Pediatric Health Care Quality and Spending. Pediatrics. 2014;133(1):96-104. doi:10.1542/peds.2012-3440.

PMID: 24366988


  • Studied a commercially-insured pediatric population enrolled in Blue Cross Blue Shield Massachusetts (BCBSMA) to determine an Alternative Quality Contract (AQC)’s effect on pediatric quality and spending in its first two years
  • Compared quality and spending pre (2006–2008) and post (2009–2010) AQC implementation, adjusting analyses for age, gender, health risk score, and secular trends
  • Special focus on Children with Special Health Care Needs (CSHCN)
  • Found that “the AQC had on average a significant, positive, and small effect on pediatric preventive care quality measures tied to P4P and that CSHCN experienced significantly greater increases in performance than non-CSHCN on those preventive measures”
  • The AQC did not affect measures not tied to P4P and had no significant effect on spending for children

Significance to Literature:

This large Alternative Quality Contract was effective in improving preventative pediatric care, with particularly significant benefits for CSHCN, but global budget arrangements need to better target care processes and outcomes to make a more significant impact on health care spending.