Managed Care

Too much variety in pay-for-performance programs?

Results from pay-for-performance (P4P) programs are spotty and few plans have set up adequate tracking methods, according to Hindy Shaman, a director in the health industries group at PricewaterhouseCoopers. How would she grade these programs?

“It has been mixed as far as the level of resources commercial plans have put in, the level of financial or nonfinancial bonus that providers get, and the amount of cost and quality tracking that payers do.” Payers have not done enough to evaluate the results of their P4P efforts, according to the PricewaterhouseCoopers report “Keeping Score: A Comparison of Pay-for-Performance Programs Among Commercial Insurers.”

“The best would be an all-payer approach, where there is a common framework for the design, quality measures, and reporting requirements. If reporting requirements are consistent, it will make everyone’s life easier. The measures might not be 100 percent right at the beginning, but at least if everyone’s on the same page, we’ll be able to tell what needs to be modified,” says Shaman.

Types of reward vary for physicians

Executives at 10 of the largest commercial payers were interviewed about their P4P programs. They were from regional and national investor-owned and not-for-profit plans, many in the Blue Cross–Blue Shield family. Collectively, they cover more than 39 million people. Color indicates that the plan offers that form of payment or reward to providers.

Source: PricewaterhouseCoopers’ Health Research Institute

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