Location
Philadelphia, PA
Start Date
8-5-2019 1:00 PM
End Date
8-5-2019 4:00 PM
Description
Background and Purpose: A goal in healthcare is to reduce costs while improving quality of care, and population health. Pay for Performance (P4P) is one intervention being utilized by Medicaid programs to achieve this goal. While P4P has become a favorite among policymakers, its effectiveness in improving health outcomes is still under investigation. We assessed the role of P4P to improve provider performance by evaluating Pennsylvania’s Medicaid Managed Care (MMC) Program.
Methods: We conducted a retrospective longitudinal analysis of providers within the HealthChoices MMC Program in Pennsylvania. We examined annual provider performance outcomes for seven providers across six measures collected between 2012 and 2016. Performance outcomes were compared to inflation-adjusted incentive payouts across providers.
Results/Outcomes: Between 2012 and 2016 controlling high blood pressure, comprehensive diabetes monitoring, prenatal care in the first trimester and annual dental visits improved between 1.2 to 6.5 percent. Performance on frequency of prenatal care and adolescent well care visits declined by 1.4 and 2.7 percent respectively. While controlling for inflation, benchmark and improvement payouts increased over time except for adolescent well care visit payouts. In 2016, payout as a percent of annual revenue ranged from 0.3 to 1.44 percent.
Conclusions: Regardless of pay-outs, the P4P initiative tracks performance measures which may be increasing provider awareness and therefore driving improvements. In addition to individual metrics, opportunities exist to consider bundled measures to see if focus on disease-approach rather than individual procedures is a more effective means to drive quality improvement and cost containment.
Clinical and Social Relevance: Pay for Performance may still be a viable solution for improving accessibility, affordability, and quality for vulnerable populations. Knowing definitively should be made a priority to best suit the health needs of Pennsylvania’s Medicaid Population.
Embargo Period
5-30-2019
Effects of Pay for Performance on Performance Outcomes in Pennsylvania’s Medicaid Managed Care Program
Philadelphia, PA
Background and Purpose: A goal in healthcare is to reduce costs while improving quality of care, and population health. Pay for Performance (P4P) is one intervention being utilized by Medicaid programs to achieve this goal. While P4P has become a favorite among policymakers, its effectiveness in improving health outcomes is still under investigation. We assessed the role of P4P to improve provider performance by evaluating Pennsylvania’s Medicaid Managed Care (MMC) Program.
Methods: We conducted a retrospective longitudinal analysis of providers within the HealthChoices MMC Program in Pennsylvania. We examined annual provider performance outcomes for seven providers across six measures collected between 2012 and 2016. Performance outcomes were compared to inflation-adjusted incentive payouts across providers.
Results/Outcomes: Between 2012 and 2016 controlling high blood pressure, comprehensive diabetes monitoring, prenatal care in the first trimester and annual dental visits improved between 1.2 to 6.5 percent. Performance on frequency of prenatal care and adolescent well care visits declined by 1.4 and 2.7 percent respectively. While controlling for inflation, benchmark and improvement payouts increased over time except for adolescent well care visit payouts. In 2016, payout as a percent of annual revenue ranged from 0.3 to 1.44 percent.
Conclusions: Regardless of pay-outs, the P4P initiative tracks performance measures which may be increasing provider awareness and therefore driving improvements. In addition to individual metrics, opportunities exist to consider bundled measures to see if focus on disease-approach rather than individual procedures is a more effective means to drive quality improvement and cost containment.
Clinical and Social Relevance: Pay for Performance may still be a viable solution for improving accessibility, affordability, and quality for vulnerable populations. Knowing definitively should be made a priority to best suit the health needs of Pennsylvania’s Medicaid Population.