Pay for Performance in Health Care: Methods and Approaches

This book provides a balanced assessment of pay for performance (P4P). P4P programs have become widespread in health care, resulting in the development and testing of new types of payment systems that are heavily featured in the new health reform law. The authors review characteristics of P4P, analyze its strengths and weaknesses, set P4P in the context of other health policy options, assess the degree to which the current enthusiasm for P4P is realistic, review how P4P programs should be evaluated to assess their impact, and consider how P4P could become more effective in the future.

Jerry Cromwell, PhD, has more than 35 years of experience conducting federally funded technical and evaluation projects in health economics. Major fields include Medicare hospital and physician payment systems and productivity gains, disease management evaluations, federal-state Medicaid public finance, physician participation in publicly funded health programs, reimbursement of anesthesia services, and disparities in access to complex health technologies. His technical expertise includes actuarial estimation of hospital inpatient and outpatient payment rates, quasi-experimental design of payment reform demonstrations, quantification of breadth and depth of state Medicaid insurance coverage and physician work effort, and econometric analysis of business cycle effects on Medicaid eligibility. He has sat on AHCPR, VA, and OTA health care study sections and testified before Congress on Medicare and Medicaid payment reforms. He is the founder and past president of Health Economics Research, which was acquired by RTI in 2002.

Michael G. Trisolini, PhD, MBA, is the director of RTI International’s Heath Care Quality and Outcomes Program. Dr. Trisolini has more than 27 years of experience in health services research and management. His research focuses on quality-of-care measurement, quality improvement programs, pay for performance, value-based purchasing, and health information technology. He has a BA from Oberlin College, an MBA from Harvard University, and a PhD from Brandeis University.

Gregory C. Pope, MS, directs RTI’s Health Care Financing and Payment program. Mr. Pope is a health economist whose primary research interest is health plan and provider payment in the US Medicare program, including pay for performance, accountable care organizations, and risk adjustment.

Janet B. Mitchell, PhD, heads RTI’s Social Policy, Health, and Economics Research unit. She received her doctorate from the Heller School at Brandeis University in 1976. She has studied physician payment under Medicare and Medicaid for many years and conducted the seminal work on bundling inpatient physician services (physician diagnosis-related groups).

Leslie M. Greenwald, PhD, is a principal scientist at RTI International. Her research interests include Medicare program policy, health care costs and payment, managed care, and health care reform. Dr. Greenwald received a BA from Dartmouth College and an MPA and PhD from the University of Virginia.