State Programs
Many states have begun to administer their own P4P state programs. Some states and state medical associations have published P4P reports detailing the P4P activities within their state. Some states and non-governmental entities have begun to publicly report health outcomes within their state (e.g. Minnesota’s community measurement project (http://www.mnhealthcare.org/). The state-sponsored P4P programs are in addition to the CMS national P4P program and as of 2010, one could still participate in both programs simultaneously.
This section is under construction on an ongoing basis. It will include both links to state P4P websites and literature describing state-specific P4P activities. If you are aware of state-specific P4P links to be included below, please feel free to contact the authors of this website.
Articles by State
Alabama: 102
Maine: 102
North Carolina: 102
Pennsylvania: 102
P4P by State Literature
(23) Smith D. Pawlenty says new health care plan will ‘transform system.’ Minneapolis Star Tribune. August 1, 2006.
Summary:
- Article briefly outlines a new Minnesota health plan called Qcare.
- Qcare is a state P4P system that sets standards for optimal care.
Significance to Literature:
One of many state P4P programs.
(57) Smith S. 2007 quality scores stall. Minnesota Medical Association: Quality review. Winter, 2008.
Link: http://www.mmaonline.net/Portals/mma/Publications/QualityReview/MMAQuali...
Summary:
- In 2007, outcome scores did not increase in Minnesota for the first time in 4 years.
- Thought to be because of increasing numbers of participating physicians; results no longer reflect only the most advanced practices.
- Also thought to be because of possible ceiling effect. “Lots of groups have done the easy things to improve quality.”
Significance to Literature:
Statewide report of sustained P4P over four years with possible ceiling effect.
***Key Article in MN***
(60) Schierman B. A Review of Pay for Performance in Minnesota. Minnesota Medical Association.November, 2007.
Link: http://www.mmaonline.net/News/NewsFullStory/tabid/2266/ArticleID/1931/CB...
Link: http://www.student.med.umn.edu/p4p/topics/.pdf
Summary:
- Document outlines 9 different P4P plans in Minnesota
- Offers charts comparing the P4P programs.
- Evaluates programs’ alignment with MMA principles August, 2007.
- Suggests recommendations for P4P in Minnesota.
Significance to Literature:
In-depth analysis of P4P in Minnesota through November 2007.
(102) Trapp D. Medicaid measures performance. American Medical News. August 6, 2007.
Link: http://www.ama-assn.org/amednews/2007/08/06/gvsa0806.htm
Summary:
- Documents growth of P4P in Medicaid.
- Provides case examples of Alabama, Maine, and Pennsylvania
- e.g. In North Carolina physicians as a whole have improved 20-25% on process measures such as flu shots.
- Questions whether P4P is worth physicians’ time due to the amount of reimbursement.
Significance to Literature:
Overview of some recent advances in Medicaid P4P.
(322) Vinz C, Foreman J, Bonneville S. Minnesota's Baskets-of-Care Project: Scope, Component, and Measurement. Minnesota Medicine. 2010
Link: http://www.minnesotamedicine.com/PastIssues/January2010/ClinicalVinzJan2...
Summary:
- Discusses the process the Minnesota department of health took, including seeking input from 140+ stakeholders and contracted with the Institute for Clinical Systems Improvement (ICSI) to create 8 baskets of care payments.
- Further gives an in depth look at patient qualifications for each basket and its associated recommended quality measures. Baskets include:
- Asthma care for children
- Diabetes
- Prediabetes
- Acute episode of low back pain
- Obstetric care
- Preventive care for adults
- Preventive care for children
- Total knee replacement
- Provides insight into the current implementation in baskets of care and directs readers to a how-to guide at http://www.health.state.mn.us/healthreform/baskets
Significance to Literature:
Offers overview of one of many new bundled payments pilot projects.
(344) Gusmano MK, Thompson FJ. An Examination of Medicaid Delivery System Reform Incentive Payment Initiatives Under Way in Six States. Health Affairs. 2015 Jul;34(7):1162-9. doi: 10.1377/hlthaff.2015.0165.
PMID: 26153311
Summary:
- Participating States are: California, Kansas, Massachusetts, New Jersey, New York, Texas
- Healthcare reform efforts have been stimulated by Medicaid waivers for Delivery System Reform Incentive Payment (DSRIP) amongst strong federal interest in replacing the Medicaid upper payment limit with pay-for-performance models
- Exploration of key characteristics of DSRIP waivers in six states and the policy context giving rise to these waivers
Significance to Literature:
Degree of success for DSRIP waivers unclear but considerable progress in planning and early implementation has been made in most DSRIP states
(449) Dale CR, Myint M, Compton-Phillips AL. Counting Better--The Limits and Future of Quality-Based Compensation. N Engl J Med. 2016 Aug 18;375(7):609-11. doi: 10.1056/NEJMp1604897.
PMID: 27532826
Summary:
- Perspective article from physician leaders of Swedish Medical Group in Seattle (part of Providence of St. Joseph Health)
- Authors indicate that while “you get what you measure” it is also true that “not everything that counts can be counted”
- Current quality measures are largely process-based which is not indicative of a clinician's worth as a compassionate diagnostician and healer
- Going forward we must:
- Measure what’s important to patients (i.e. functional status, depression free days, total costs)
- Balance process metrics that are closer to the physician’s control with outcome measures that better capture quality, while prioritizing metrics most closely linked with health outcomes
- Acknowledge metric limitations for compensation but also provide support tools that make it “ridiculously easy to do the right thing” and produce high-value care
Significance to Literature:
“Rather than ceding reimbursement redesign to insurers, provider groups can lead the way with value-based clinician compensation”