Pay for Performance: More than Just Accountability and Value – Better Outcomes

04 Dec Pay for Performance: More than Just Accountability and Value – Better Outcomes

In recent years, the concept of pay-for-performance has gained in popularity both in private industry and government. It has become an important and effective tool for reform in healthcare and among policymakers. Both private and public payers, including Medicare and Medicaid, take advantage of this payment model. In healthcare, pay-for-performance is an umbrella term for efforts designed to manage costs and to increase returned value by introducing truly effective programs with measurable outcomes.

Pay-for-performance programs in healthcare provide a financial incentive to participating groups in meeting key performance indicators. Medicare and Medicaid have various pay for performance initiatives already in hospitals and clinics. These incentives may not only improve quality measures in hospitals but may also help to decrease patient stay times.

If pay-for-performance is implemented properly, it will not only deliver a return on investment while it measures success, it can affect patient long-term outcomes as well. According to a peer-reviewed, longitudinal study published in October 2017 by the US Center for Disease Control and Prevention, pay-for-performance programs have shown a decrease in cancer-related, diabetes-related, and all-cause mortality.¹

On a Federal level, in January of 2017, a bill was introduced in the U.S. House of Representatives sponsored by Congressman Patrick Tiberi of Ohio, along with 14 co-sponsors. The goal of this bill, known as the “Social Impact Partnerships to Pay for Results Act” [H.R. 576], is to help redirect funds away from ineffective social programs and use these funds to create social impact partnerships with demonstrable and measurable effects. This bill may help to create fulfilling jobs while paying partners upon measurable improvements. Additionally, it could save money from many current, ineffective programs, or at least those difficult to measure.

The “Social Impact Partnerships to Pay for Results Act” plans to use this payment model to support initiatives that have a compelling social benefit or create savings for the federal, state, or local government. Healthcare reform is one important initiative in HR 576. The initiatives range from improving high school graduation rates to increase the independence of disabled individuals, and it includes many other ways to improve the general health and well-being of Americans.

This bill has been passed to both the House Committee on Ways and Means and the House Committee on Oversight and Government Reform. These two committees have respective jurisdiction to consider provisions included in this bill. On February 1, 2017, the Committee on Ways and Means had referred the bill to the Subcommittee on Human Resources. This bill was also introduced in the Senate by Senator Todd Young of Indiana, on April 27, 2017, under the same name [S.963]. It has subsequently been referred to the Committee on Finance.

Qmetis has met with Congressman Tiberi on HR 576 and Senator Young on S.963 and continues to support pay for performance as an approach to provide better value and, better patient outcomes.

^{1- Hsieh, Hui-Min, et al. “A Diabetes Pay-for-Performance Program and Risks of Cancer Incidence and Death in Patients with Type 2 Diabetes in Taiwan.” Preventing Chronic Disease, vol. 14, October 2017, doi:10.5888/pcd14.170012.}