This project will assess the various types and prevalence of healthcare initiatives in which payment is used as a mechanism to incentivize or reward higher quality of care – i.e., so-called “pay for performance” programs – and determine what design strategies or other characteristics of these programs are known to produce the desired outcome. As well, the project will examine what things are associated with a lack of success and what are the current major gaps in knowledge regarding pay for performance.
Currently, the prevailing methods of paying for healthcare in the United States neither incentivize nor reward providing high quality care. The soaring costs of healthcare, coupled with an increasing knowledge of the extent of poor quality care, have made clear the need for a major transformation of the way that healthcare is financed in the United States. Standardization of evidence-based performance measures that are endorsed by NQF through multi-stakeholder consensus gives healthcare purchasers a common mechanism for evaluating providers and linking their performance to reimbursement. Today, a number of groups have launched initiatives that explore ways to align provider performance with reimbursement by using measures such as those endorsed by NQF, with the ultimate goal of driving provider change and improving quality for patients. However, there also is potential for unintended, adverse consequences when linking quality measurement to reimbursement, and there is an acute need to ensure that the evolving portfolio of pay for performance programs follow principles that enhance the likelihood of success and minimize the chance of adverse consequences.
A multi-stakeholder conference will be convened on March 1-2, 2005 in the greater Washington, DC, area to review the array of pay for performance initiatives currently underway across the country and to determine what lessons can be learned from these efforts at this time, with an eye towards identifying a common set of principles for designing and implementing pay for performance programs.
This project, like all NQF activities, will involve the active participation of representatives from across the spectrum of healthcare stakeholders. The project will seek input from all key stakeholders. This project will not utilize the NQF Consensus Development Process per se since it is not intended to result in voluntary consensus standards.
For more information, please contact Helen Wu, MSc. at 202.783.1300 or email at info@qualityforum.org.