Research Links on Pay-for-Performance

Agency for Healthcare Research and Quality

http://www.ahrq.gov/qual/measurix.htm

The Agency for Healthcare Research and Quality's (AHRQ) mission is to improve the quality, safety, efficiency, and effectiveness of health care for all Americans. Information from AHRQ's research helps people make more informed decisions and improve the quality of health care services. AHRQ was formerly known as the Agency for Health Care Policy and Research.

American Academy of Family Physicians (AAFP)
http://www.aafp.org/fpm/20040300/45gett.html

Founded in 1947, the American Academy of Family Physicians represents more than 93,700 physicians and medical students nationwide. It is the only medical specialty society devoted solely to primary care.

American Medical Association –
Pay-for-Performance Guidelines

http://www.ama-assn.org/ama/pub/category/14416.html

On March 2, 2005, the American Medical Association released a new set of pay-for-performance principles and guidelines for the formation and implementation of pay-for-performance programs.  

American Medical Association –
Physician Consortium for Performance Improvement

http://www.ama-assn.org/ama/pub/category/2946.html

The Physician Consortium for Performance Improvement is a group of clinical and methodological experts convened by the American Medical Association (AMA).  The Consortium includes representatives from more than 60 national medical specialty and state medical societies, the Agency for Healthcare Research and Quality, and the Centers for Medicare and Medicaid Services.  

Bridges to Excellence
http://www.bridgestoexcellence.org

The Bridges to Excellence coalition is a not-for-profit organization created to encourage diverse significant leaps in the quality of care by recognizing and rewarding health care providers who demonstrate that they deliver safe, timely, effective, efficient and patient-centered care. Bridges to Excellence participants include large employers, health plans, the National Committee for Quality Assurance, MEDSTAT and WebMD Health, among others.

Care Focused Purchasing
http://www.mercerhr.com/pressrelease/details.jhtml?idContent=1132360

Care Focused Purchasing (CFP) is a collective initiative that currently involves 28 large employers covering approximately 2 million employees and their dependents. The employer group is currently working on adopting from existing sources a set of standardized performance measures of quality and efficiency for hospitals and physicians, sharing provider performance measures with employees and employers to help them make better informed decisions and creating market demand for open and accessible information about hospital and physician performance.

Center for Studying Health System Change
http://www.hschange.org/CONTENT/675/

Growing national attention to improving quality and patient safety is spurring development of quality-based financial incentives for physicians and hospitals. Health plans in particular are driving these pay-for-performance initiatives, according to findings from the Center for Studying Health System Change's (HSC) 2002-03 site visits to 12 nationally representative communities.

Doctors' Office Quality - Information Technology (DOQ-IT)
http://www.doqit.org/doqit/jsp/index.jsp

Doctors' Office Quality Information Technology (DOQ-IT) promotes the adoption of electronic health record (EHR) systems and information technology (IT) in small-to-medium sized physician offices with a vision of enhancing access to patient information, decision support, and reference data, as well as improving patient-clinician communications.

The Centers for Medicare and Medicaid Services (CMS) has awarded Lumetra the role of lead Quality Improvement Organization (QIO)in partnership with the American Academy of Family Physicians' (AAFP) Center for Health Information Technology.

Florida Health Care Coalition
http://www.cfhcc.net/programs/initiatives/quality.html

This coalition represents over one million members from public and private Florida employers, and has been recognized nationally for its quality initiatives. After successfully developing tools to measure and reward inpatient performance, CFHCC is now creating an outpatient model for doctors who make a living in their office.

Integrated Healthcare Association
http://www.iha.org

The Integrated Healthcare Association (IHA) is composed of top decision-makers from the major health care stakeholder groups in California. Its mission is to promote the continuing evolution of integrated health care, supported by financial mechanisms that align incentives of purchasers, payors, and providers, as the best means to achieve positive outcomes for the patient and the general public.

Joint Commission on Accreditation of Healthcare Organizations
http://www.jcaho.org/news+room/news+release+archives

The Joint Commission evaluates and accredits nearly 16,000 health care organizations and programs in the United States. An independent, not-for-profit organization, the Joint Commission is the nation's predominant standards-setting and accrediting body in health care. The organization recently unveiled a set of Principles to guide the development and refinement of health care pay-for-performance programs.

Leapfrog Group
http://www.leapfroggroup.org/rewards_compendium

The Leapfrog Group is an initiative driven by organizations that buy health care who are working to initiate breakthrough improvements in the safety, quality and affordability of healthcare for Americans. With support from The Commonwealth Fund and The Robert Wood Johnson Foundation, the organization has developed the first public Web-based compendium of incentive and reward programs aimed at improving health care in both in-patient and out-patient settings.

MN Community Measurement Project
http://www.mnhealthcare.org

MN Community Measurement© is a new nonprofit entity dedicated to improving the quality of health care in Minnesota. The organization was formed to improve care and support quality initiatives for providers throughout the state, reduce reporting-related expenses for medical groups, health plans and regulators and communicate findings in a fair, usuable and reliable way. The companies forming MN Community Measurement were Blue Cross and Blue Shield of Minnesota/Blue Plus, First Plan of Minnesota, HealthPartners, Medica, Metropolitan Health Plan, Preferred One and UCare Minnesota. StratisHealth also contributes data to the initiative.

National Committee for Quality Assurance (NCQA)
http://www.ncqa.org/Programs/PGO/pgoip.htm

The National Committee for Quality Assurance (NCQA) is a premier source for information about the quality of the nation’s managed care plans. NCQA is an independent, 501(c)(3) non-profit organization whose mission is to improve health care quality everywhere. It is involved in several P4P initiatives.

National Health Care Purchasing Institute
http://www.nhcpi.net/pdf/models.pdf

The NHCPI was founded to improve health care quality by advancing the purchasing practices of major corporations and government agencies, particularly Fortune 500 companies, Medicare, and public employers. The group has sponsored a report called “Provider Incentive Models for Improving Quality of Care.

National Quality Forum
http://www.qualityforum.org

The National Forum for Health Care Quality Measurement and Reporting (National Quality Forum or NQF) is a not-for-profit membership organization created to develop and implement a national strategy for health care quality measurement and reporting. A shared sense of urgency about the impact of health care quality on patient outcomes, workforce productivity, and health care costs prompted leaders in the public and private sectors to create the NQF as a mechanism to bring about national change.

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Pay-for-Performance Literature Review

Arrow KJ (1963). "Uncertainty and the welfare economics of medical care." Am Econ Rev: 941-973.

Bailit Health Purchasing, L. (2002). Provider incentive models for improving quality of care. Prepared for the National Health Care Purchasing Institute: An Initiative of the Robert Wood Johnson Foundation.

Casalino L., R. R. Gillies, et al. (2003). "External incentives, information technology, and organized processes to improve health care quality for patients with chronic diseases." Jama 289(4): 434-41.

Epstein, A. M., T. H. Lee, et al. (2004). "Paying physicians for high-quality care." N Engl J Med 350(4): 406-10.

Fisher E. S., D. E. Wennberg, et al. (2003). "The implications of regional variations in Medicare spending. Part 1: the content, quality, and accessibility of care." Ann Intern Med 138(4): 273-87.

Hall, M. A., E. Dugan, et al. (2002). "How disclosing HMO physician incentives affects trust. Not all cost-minimizing physician incentives are ethically troubling to patients." Health Aff (Millwood) 21(2): 197-206.

Hofer, T. P., R. A. Hayward, et al. (1999). "The unreliability of individual physician "report cards" for assessing the costs and quality of care of a chronic disease." Jama 281(22): 2098-105.

Institute of Medicine (2001). Crossing the quality chasm: a new health system for the 21st century. Washington, D.C., National Academy Press.

Kralewski, J. E., E. C. Rich, et al. (2000). "The effects of medical group practice and physician payment methods on costs of care." Health Serv Res 35(3): 591-613.

McGlynn, E. A., S. M. Asch, et al. (2003). "The quality of health care delivered to adults in the United States." N Engl J Med 348(26): 2635-45.

Roland, M. (2004). "Linking physicians' pay to the quality of care--a major experiment in the United kingdom." N Engl J Med 351(14): 1448-54.

Schuster, M. A., E. A. McGlynn, et al. (1998). "How good is the quality of health care in the United States?" Milbank Q 76(4): 517-63, 509.

Shortell SM (2004). "Increasing value: a research agenda for addressing the managerial and organizational challenges facing health care delivery in the United States." Med Care Res Rev 61(3): 12S-30S.

Soumerai, S. B. (2004). "Benefits and risks of increasing restrictions on access to costly drugs in Medicaid." Health Aff (Millwood) 23(1): 135-46.

Strunk BC, H. R. (2004). Paying for quality: health plans try carrots instead of sticks. Issue brief: findings from HSC. Washington, D.C.: 1-4.

Town R, K. J., Dowd B (2004). "Assessing the influence of incentives on physicians and medical groups." Med Care Res Rev 61(3): 80S-118Ss.

Zaslavsky, A. M., J. N. Hochheimer, et al. (2000). "Impact of sociodemographic case mix on the HEDIS measures of health plan quality." Med Care 38(10): 981-92.

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