Pay for performance can work in a Medicaid managed care setting, but only if plans place enough dollars at stake and communicate well with providers, researchers from Mathematica Policy Research say in a Health Affairs web exclusive.
In work supported by the California HealthCare Foundation (CHCF), the Mathematica authors describe the results of a 2003-05 pay-for-performance demonstration aimed at improving the timeliness of well-baby care. The demonstration involved seven California Medicaid managed care plans operating in different regions.
Five of the plans implemented various new incentives for physicians and other primary care providers, while two did not. The specific goal of all five incentive programs was to ensure that providers saw infants for six well-baby checkups in the infants’ first 15 months of life. The plans varied greatly in size; the smallest had 72 primary care providers serving infants, while the largest had more than 2,000 such providers.
The overall results of the demonstration were mixed at best: Provider incentives appear to have yielded significant results in only one plan. That plan conducted good communications with providers, and provided “stair-step” well-baby incentives, meaning that providers achieved bonuses for each additional well-baby visit, with a maximum award to each provider of $470 per baby on top of the provider’s regular capitated payment.
