Use the research and reports in this section in your efforts to incentivise hospitals to provide high quality care.

MedPac Incentive Recommendations for Medicare - MedPAC recommends that Medicare pursue demonstrations of provider payment differentials and revised payment structures to improve quality. The program should focus its efforts to improve quality in three areas: (1) settings that offer ready measures and standardized data collection—Medicare+Choice plans and inpatient rehabilitation facilities; (2) settings—such as hospitals and physician offices—that affect a large number of beneficiaries; and (3) care delivered across settings. This chapter focuses on four main themes: how incentives relate to health care quality; private sector use of incentives; applying incentives to improve quality in Medicare; and examples of private sector efforts to use incentives to improve quality. Click the link above to read the full chapter.

Health Affairs article on Paying for Performance - Paying health care providers to meet quality goals is an idea with widespread appeal, given the common perception that quality of care in the United States remains unacceptably low despite a decade of benchmarking and public reporting. There has been little critical analysis of the design of the current generation of quality incentive programs. In this paper we examine public reports of paying for quality over the past five years and assess each of the identified programs in terms of key design features, including the market share of payers, the structure of the reward system, the amount of revenue at stake, and the targeted domains of health care quality. Click the link above to read the full report.

Med-Vantage Paying for Performance Briefing - This executive briefing summarizes research on provider pay for performance incentive programs (P4P) in healthcare in the United States. The research was conducted by Med-Vantage, Inc., a healthcare consulting firm specializing in care management information technology and P4P deployment, under sponsorship by ViPS, Inc., a leading provider of healthcare business intelligence solutions. Click the link above to learn more about the research on provider pay for performance incentive programs and combine with other Leapfrog resources to create one for your organization.

eHealth Initiatives Financial Incentives for Health IT - Misaligned incentives and payment policies have long been considered a major barrier to widespread adoption and diffusion of information technology in the US health care system. Those who pay for health information technology (HIT) are often not the ones who directly benefit from the technology investment. For example, when a provider (physician/hospital) invests in HIT, the payer (health plan and employer) may be the most direct beneficiary, with savings from improvements in population health management, improvements in formulary compliance, decreased lost work days, and increased employee productivity. Consumers are also likely to benefit directly if HIT products deliver on promised improvements in patient safety and quality of care.

The purpose of this study is to identify a range of models intended to address misaligned financial incentives. Our research is based on a comprehensive literature review and interviews with individuals directly involved in HIT financial incentive programs or involved in the study of financial incentives. Our primary focus is on private sector models to address payment system issues. Based on this research we craft a structure for understanding these programs, with a focus on the decisions that communities face in experimenting with new HIT programs. Click the link above to read the full study.

Boeing Enrollment and Benefits Assesment Survey- The Boeing Company, a founding member of The Leapfrog Group, applied in April 2003 to become a pilot site for the Incentive and Rewards program sponsored by The Leapfrog Group with support from the Agency for Healthcare Research and Quality (AHRQ).  The purpose of the Boeing pilot program is to measure the impact of a variable hospital benefit for certain employees enrolled in the Traditional Medical Plan (TMP).  Boeing plans to utilize information from this pilot to make determinations for future benefit plans for other employee populations and hopes the information obtained from the pilot evaluation will aid in realizing better health and financial outcomes for the affected populations.  The pilot program is being evaluated through the use of two telephone surveys of Boeing employees/beneficiaries; one conducted prior to the July 1, 2004 effective date of the variable hospital benefit, and one after the implementation of the benefit.  Employees with a recent hospitalization, and those who have not been hospitalized, are being surveyed.  In order to compare differences in hospital and health plan decision-making, as well as assess basic knowledge and understanding of safety and quality, employees who are not subject to the hospital safety incentive also are being surveyed.  This report summarizes the results of the first survey, administered from March through May 2004.

While the detailed results are presented in the text that follows, the following is a short summary of major conclusions from the analysis.

• Boeing consumers are generally aware of recent health care communications campaigns by the company.
• Consumers understand that there is a chance of general medical errors and harm, and that there is variation in errors and harm among hospitals in a community
• Existing physician relationships are important and because of limited hospital staff privileges, may limit the impact of consumer driven approaches aimed at using Leapfrog compliant hospitals.