Pay for performance/incentives
The Oregon Health Authority (which oversees the State Medicaid program) initiated a series of policy changes to promote earlier detection, more effective referrals, and better coordination of care for pediatric patients with developmental delays, leading to a significant increase in screening rates and enhanced access to early intervention services.
A statewide measurement and reporting system serves as a single, comprehensive, credible source of information on provider performance, leading to significant improvements in performance over time and to adoption and use of the system by local and national payers and other organizations.
A combined State-Federal program pays health plans a capitated fee to provide and coordinate acute, primary, long-term care as well as social services to those eligible for Medicare and Medicaid, leading to enhanced access to care, fewer inpatient admissions and nursing home placements, and high levels of beneficiary and provider satisfaction.
Intensive, concurrent medical and behavioral health care, addiction services, and social service coordination improve patient outcomes and reduce health system use among patients who historically have been frequent users of emergency departments.
HealthSpring's Partnership for Quality program offers bonuses to physician practices and onsite care coordination and disease management support, leading to significantly better outcomes and reduced costs for Medicare Advantage enrollees.
A plan-supported medical home model used by clinics serving Medicaid managed care beneficiaries enhances access to care, improves quality, and reduces inpatient admissions.
A large medical group developed a comprehensive strategy to increase the number of physicians who speak languages other than English in order to improve access for patients with limited English proficiency.
Financial incentives used by all Maryland public and private payers significantly reduce hospital-acquired conditions in hospitals throughout the state.
A statewide, all-payer initiative creates financial incentives tied to hospital performance on process, patient experience, and outcomes measures, leading to better and less variable performance.
A collaborative initiative features standardized care elements and fixed per-patient payments for treatment of depression in the primary care setting, leading to high rates of remission and response to treatment and high levels of provider satisfaction.