Targeted Solicitation on Quality Improvement and Performance Measurement

Pay-for-Performance incentives' effect on disparities

Dates of Projects:  The six projects funded through the Targeted Solicitation on Quality Improvement and Performance Measurement ran from December 2008 through September 2012.

Researchers investigated the effects of pay-for-performance incentive programs for health plans, hospitals, and physicians on health care quality overall and specifically on health care disparities among racial and ethnic minorities.

Key Findings:

  • The Maryland Quality-Based Reimbursement Program seemed to have no consistent impact on quality of care.
  • Both intervention and non-intervention groups in a pay-for-performance program at federally qualified health centers in Hawaii significantly improved one of two areas addressed.
  • The Premier Hospital Quality Improvement Demonstration had no impact on patient outcomes in U.S. hospitals, and Premier did not have detrimental effects on racial and ethnic disparities in either processes of care or in patient outcomes.
  • Among outpatient practice sites participating in the Bronx, N.Y., CHAMPION pay-for-performance program, improvements in care in multiple quality domains occurred for the total group of patients studied and for African American/Black race, Hispanic/Latino ethnicity, and Spanish language-preferred groups.
  • In a study of the California Pay for Performance Program, physician groups practicing in areas with higher socioeconomic status had better performance scores. Physician groups that served more disadvantaged patients and that were smaller and less well-resourced performed less well on the pay-for-performance clinical metrics.
  • California’s “auto-assignment” pay-for-performance program directed at health plans did not significantly improve quality or reduce disparities among participating versus non-participating Medicaid managed care plans.