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Reimbursement Methods - Managed Care

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Hello, can you please find at least two published peer-reviewed journal articles within the last 3 years related to the new reimbursement methods (i.e., pay-for-performance/P4P, volume discounting, wellness incentives, etc.) implemented in any managed care model. Summarize the results and specify the advantages and disadvantages according to the patient population and quality/access to care criterion 2-3 pages, excluding references. Thanks.

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Changing the method of payment, either through pay-for-performance or high-deductible health plans impact consumers' access to care or quality of care in some fashion, according to research. There are many variables that must be considered including individual populations based on health needs as well as socioeconomics. Health care needs and costs do not exist in a vacuum and these variables must be considered when weighing the impact of the plan on consumers. The following studies look at the impact of pay-for-performance measures and of high-deductible health plans on different patient populations and the impact on quality of care and access to care.

Chien, A.T., Wroblewski, K., Damberg, C., Williams, T.R., Yanagihara, D., Yakunia, T., Casalino, L.P. (2012, 27 May). Do physician organizations located in lower socioeconomic status areas score lower on pay-for-performance measures? J Gen Intern Med. 2012 May 27(5): 548-54. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/22160817

The authors of this paper examine the association between physician organization (PO) location and pay-for-performance (P4P). The study was performed to determine if physician organizations - independent practice associations and medical groups - located in lower socioeconomic status areas score poorly in pay-for-performance programs. The authors studied the Integrated Healthcare Associations pay-for-performance program, which is the largest non-governmental, multi-payer program for physician organizations in the United States. The results were measured quantitatively by utilizing the geo-coding data of 11,718 practice sites with 160 physician organizations and weighing their tracts against tract specific socioeconomic status based on the number of primary care physicians at each site. Pay-for-performance was defined by the Integrated Healthcare Associations program and was a composite that included quality, measure of patient experience, and information technology.

It was determined that the physician organizations' performance scores in the major pay-for-performance program vary by the socioeconomic status area in which their practice was located. As a result, pay-for-performance programs are likely to pay higher bonuses to physician ...

Solution Summary

This solution summarizes the results of two recently published peer-reviewed journal articles, and specifies the advantages/disadvantages to the patient population and quality/access to care criterion. APA formatted references are included.

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