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Provider performance measures in private and public programs: achieving meaningful alignment with flexibility to
Aparna Higgins1, German Veselovskiy, Lauren McKown
1America's Health Insurance Plans, Washington, DC, USA. ahiggins@ahip.org
Health Affairs (Project Hope)
|August 7, 2013
Summary
Private payers increasingly use provider performance measures for quality improvement and payment. A study of 23 health plans found significant variation in measure use, highlighting the need for both consistency and flexibility in healthcare quality initiatives.
Area of Science:
- Health Services Research
- Quality Improvement Science
- Healthcare Management
Background:
- Provider performance measures are increasingly utilized for healthcare quality improvement, payment determination, and public reporting.
- Private payers' adoption of these measures is a critical aspect of the evolving healthcare landscape.
Purpose of the Study:
- To characterize the utilization of provider performance measures by private payers.
- To compare the application of these measures across private and public healthcare programs.
Main Methods:
- Survey data collected from 23 large health plans, representing 66% of national commercial enrollment (121 million enrollees).
- Analysis of the types and frequency of distinct performance measures reported by these health plans.
Main Results:
- Health plans reported using a substantial number of distinct performance measures (546).
- Significant variability was observed in the use of performance measures within both private and public payment and care delivery systems.
- Common areas of focus for performance measures included cardiovascular conditions, diabetes, and preventive services.
Conclusions:
- The widespread use of provider performance measures by private payers is evident, but significant variation exists.
- Policy efforts to standardize performance measures should consider the need for flexibility to accommodate diverse populations and foster innovation in healthcare delivery.
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