An alternative to pay-for-performance: one health plan's approach to quality improvement

To address concerns about the quality of care, health plans have used varying approaches to support quality improvement (QI). Pay-for-performance (P4P) is the most commonly used and discussed approach. P4P programs have many challenges in design and execution, particularly for Medicaid providers. In order to find an alternative to P4P, CareOregon--a nonprofit health plan serving Medicaid and Medicare enrollees--developed the Care Support and System Innovation (CSSI) Program. An evaluation was conducted to assess the overall affect of the CSSI Program in promoting comprehensive improvements in quality of care and the extent to which it has the potential to offer a viable alternative to P4P. The evaluation found that the CSSI Program successfully addressed many challenges inherent in P4P. The CSSI Program engaged providers, fostered a culture of QI within CareOregon's network, and provided practices with the opportunity to develop sustainable and innovative solutions to address quality concerns. Success of the program was attributed to CareOregon's focus on building relationships while providing technical assistance and responsive funding. While health outcome data were not available to assess impact on CareOregon's members, evaluation findings highlight the importance of collaboration in QI efforts, and suggest that the model has the potential to overcome many of the challenges faced by P4P.