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Published on: June 21, 2018
Pharmacy management approach: how do we align all the incentives?
1SelectHealth Plans, 4646 West Lake Park Blvd., Suite N3, Salt Lake City, UT 84120, USA. Jeffrey.Dunn@selecthealth.org
Journal of Managed Care Pharmacy : JMCP
|March 8, 2007
Summary
Pay for performance (P4P) initiatives use clinical evidence and metrics to incentivize health care providers, aiming to improve care quality. While P4P programs are growing, their impact on outcomes and costs requires further data.
Area of Science:
- Health Services Research
- Health Economics
- Quality Improvement
Background:
- Rising healthcare costs and employer burden necessitate improved healthcare quality.
- Pay for Performance (P4P) initiatives are emerging as a strategy to address this disconnect.
- Current healthcare delivery models show a gap between rising costs and quality improvements.
Purpose of the Study:
- To examine the necessity of P4P in contemporary healthcare.
- To review the design, components, and outcomes of existing P4P programs.
- To understand how financial incentives align provider and payer goals.
Main Methods:
- Analysis of P4P program structures and incentive mechanisms.
- Review of metrics used to measure healthcare quality in P4P.
- Examination of incentive types including bonuses, fee schedules, and withholds.
Main Results:
- P4P programs utilize clinical evidence and metrics (clinical, patient satisfaction, efficiency, technology) to drive incentives.
- Managed care organizations (MCOs) employ P4P to align physician and MCO goals.
- A case study of SelectHealth's P4P program showed success in primary care and pharmacy utilization.
Conclusions:
- P4P programs are increasingly adopted in managed care settings.
- Challenges persist, and robust data on P4P's impact on outcomes and cost management is limited.
- Further research is needed to validate the effectiveness of P4P initiatives.
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