Newswise — RESEARCH TRIANGLE PARK, NC—A new book written by RTI International researchers provides the most comprehensive review to date of U.S. health care pay-for-performance programs.
Pay-for-performance is an approach used to provide incentives to physicians and health care provider organizations to achieve improved performance by increasing quality of care or reducing costs.
Pay for Performance in Health Care: Methods and Approaches identifies and evaluates the full range of issues associated with implementing pay-for-performance models. It gives policy makers and researchers thorough descriptions of alternative pay-for-performance models, examines their pros and cons, and discusses lessons learned from prior experience with these models.
"Pay-for-performance programs have become widespread in health care in just the past decade and have generated a great deal of enthusiasm in health policy circles and among legislators, despite limited evidence of their effectiveness," said Janet Mitchell, Ph.D., vice president of Social Policy, Health, and Economics Research at RTI and one of the book's editors. "We anticipate that a 'second generation' of pay-for-performance programs can now be developed that can have greater impact and be better integrated with other interventions to improve the quality of care and reduce costs."
According to the authors, results to date suggest that pay-for-performance programs cannot guarantee improved quality of care, better health care value, or meaningful net health care savings—or a "bending of the cost curve."
Addressing both pay-for-performance's promise and shortcomings, the book was written to help guide the Secretary of Health and Human Services and other policy makers in designing, implementing and evaluating pay-for-performance and value-based purchasing programs under the Affordable Care Act, which was part of the 2010 health care reform.
The book may also greatly benefit private sector insurers as they seek to redesign their own payment and quality improvement systems.
"This change in health care payment approach offers providers incentives to consider the quality, value, and cost of the health care delivered," Mitchell said. "It allows providers to shift away from the opposite incentives that traditional fee-for-service gives providers to increase the volume of profitable services."
The authors recommend improvements on current initiatives and suggest developing more effective second-generation pay-for-performance programs. They also suggest ways in which Affordable Care Act provisions could be implemented most effectively by the Secretary of Health and Human Services.
In recent years, Medicare and some programs in the private sector have experimented and continue to experiment with the broad notion of pay-for-performance. As part of the enactment of the Affordable Care Act, many of the Medicare pay-for-performance initiatives have just begun. Evaluations of these programs will provide key evidence for future revisions of pay-for-performance in health care. Many of them build upon earlier Medicare demonstration efforts, which the book authors find have had mixed success at best.
Pay for Performance in Health Care: Methods and Approaches was published by RTI Press and is available on the RTI Press website http://www.rti.org/publications/rtipress.cfm?pid=16784.
About RTI InternationalRTI International is one of the world's leading research institutes, dedicated to improving the human condition by turning knowledge into practice. Our staff of more than 2,800 provides research and technical expertise to governments and businesses in more than 40 countries in the areas of health and pharmaceuticals, education and training, surveys and statistics, advanced technology, international development, economic and social policy, energy and the environment, and laboratory and chemistry services. For more information, visit www.rti.org.
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