Discussions with program sponsors, hospitals, and data vendors revealed the following lessons about P4P program design and operation:
An Environmental Scan of Pay for Performance in the Hospital Setting: Final Report. Theoretical Literature and Implications for P4P Design
P4P is common in industries other than health care, and economists and management experts have studied and developed theories on how individuals respond to financial incentives. The economic and management theories that we reviewed suggest that the way in which P4P incentives are structured, or framed, could influence whether they achieve the de
An Environmental Scan of Pay for Performance in the Hospital Setting: Final Report. The Empirical Literature on Hospital P4P
As of June 2007, few peer-reviewed studies existed on the use of financial incentives and their impact on quality, patient experience, safety, or the efficient use of resources.
An Environmental Scan of Pay for Performance in the Hospital Setting: Final Report. An Environmental Scan of Hospital Pay for Performance
The DRA required the Secretary of the DHHS to consider the following design elements when developing the VBP plan: (1) the process for developing, selecting, and modifying measures of quality and efficiency; (2) the reporting, collection, and validation of quality data; (3) the structure, size, and source of value-based payment adjustments; and (4
Mounting cost pressures and substantial deficits in the quality of care within the U.S.
In recent years, pay-for-performance (P4P) programs have emerged as a strategy for driving improvements in the quality, safety, and efficiency of delivered health care. In 2005, with passage of the Deficit Reduction Act, Congress mandated that the Secretary of the Department of Health and Human Services (DHHS) develop a plan for value-based purcha
Prepared by: RAND Health working paper series CHERYL L.DAMBERG, MELONY SORBERO, ATEEV MEHROTRA, STEPHANIE TELEKI, SUSAN LOVEJOY, AND LILY BRADLEY Prepared for: Office of the Assistant Secretary for Planning and Evaluation (ASPE) U.S. Department of Health and Human Services (HHS) Prepared Under: WR-474-ASPE/CMS
Consumer Protection in Private Health Insurance: The Role of Consumer Complaints. Appendix 5 - References
Bodenheimer T “California’s Beleaguered Physician Groups – Will they survive?” New England Journal of Medicine , 2000, 342(14):1064-1068 Brewster LR, Jackson L and CS Lesser “Insolvency and Challenges of Regulating Providers that Bear Risk”, Issues Brief , Center for Studying Health System Change, February 2000, Number 26 Gorml
Consumer Protection in Private Health Insurance: The Role of Consumer Complaints. Appendix 4 - List of NAIC and State Attachments
Attachments - NAIC 1. National Association of Insurance Commissioners, Consumer Complaint White Paper , Draft of 13 March 2000 Attachments – California
Consumer Protection in Private Health Insurance: The Role of Consumer Complaints. Appendix 3 - Interview Questionnaire Employers
1. Do you get involved when your employees have a specific complaint about a health plan, as distinct from general information inquiries about benefit coverage or eligibility? 2. What is the nature of your involvement in employee complaints about health plans? Do you ring, write or fax the health plan? Is there a nominated contact in the health
Consumer Protection in Private Health Insurance: The Role of Consumer Complaints. 1. Co-Ordination and Liaison
Jurisdiction and relationship with other government agencies:
Consumer Protection in Private Health Insurance: The Role of Consumer Complaints. Appendix 1 - List of Interviewees
California Judy Penman Supervisor Hotline Consumer Communications Bureau California Department of Insurance Phone: (213) 346-6817 Peter Lee Executive Director Center for Health Care Rights Phone: (213) 383-4519 Maryland
Consumer Protection in Private Health Insurance: The Role of Consumer Complaints. 4. Grievances (internal complaints received by health insurance plans) are a potentially rich data source in examining the implementation of patient protections. In five of the six states regulators stipulate the framework for grievance data that insuranc
Table 10.4 outlines the management and reporting of grievances in the six states studied. The NAIC Consumer Complaint White Paper does not refer to grievances managed directly by insurance plans and hence is not included in this table. The term “grievance” is used in this report to mean any complaint made by a consumer directly to a health ins
Consumer Protection in Private Health Insurance: The Role of Consumer Complaints. 3. The existence and standard of consumer “report cards” on health insurance complaints vary substantially. There are some good examples of best practice, but some reports are overly complex and provide insufficient guidance to consumers.
An NAIC survey of state insurance regulators undertaken in 1999 found that only 26 states affirmatively published complaint information “in either an annual report, consumer brochure or on the Department’s web site”. Readers are reminded that the four states with published reports (California, Oregon, New York and Texas) discussed below repr