Evaluating a Pay-for-Performance Program for Medicaid Children in an Accountable Care Organization
Sean Gleeson1, Kelly Kelleher1, William Gardner2
1Partners for Kids, Columbus, Ohio2Department of Pediatrics, Ohio State University, Columbus3Nationwide Children's Hospital, Columbus, Ohio.
JAMA Pediatrics
|January 27, 2016
Summary
Pay for performance (P4P) showed modest improvements in pediatric primary care physicians within an accountable care organization (ACO). However, other interventions may be more effective for enhancing quality across pediatric health systems.
Area of Science:
- Pediatric Health Services Research
- Healthcare Quality Improvement
- Accountable Care Organizations
Background:
- Pay for performance (P4P) incentivizes healthcare providers for improved care processes and outcomes.
- P4P has not been previously studied in pediatric accountable care organizations (ACOs).
Purpose of the Study:
- To evaluate the impact of P4P on pediatric primary care physician performance within an ACO.
- To determine if P4P incentivizes improved quality of care for children.
Main Methods:
- Retrospective cohort study (2010-2013) using a differences-in-differences design.
- Analyzed data from 2966 physicians and 323,812 patients in a pediatric ACO serving Medicaid children.
- Compared performance on 21 Healthcare Effectiveness Data Information Set (HEDIS) measures between incentivized and non-incentivized physician groups.
Main Results:
- Incentivized physicians showed modest improvements in specific well-visit and immunization measures compared to non-incentivized community physicians.
- Employed physicians at a hospital demonstrated greater performance improvements than incentivized community physicians on several measures.
- The impact of P4P on overall pediatric performance within the ACO was limited.
Conclusions:
- P4P led to minor enhancements in physician performance within the pediatric ACO.
- Alternative interventions may offer greater potential for quality improvement in pediatric healthcare systems.
- Further research is needed to optimize quality enhancement strategies for large pediatric health networks.
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