Levin-Scherz Jeffrey, DeVita Nicole, Timbie Justin
Partners Community HealthCare, Inc.
Med Care Res Rev. 2006 Feb;63(1 Suppl):14S-28S. doi: 10.1177/1077558705284057.
This article reviews the experience of a large, heterogeneous integrated delivery network that incorporated physician quality metrics into pay-for-performance contracts. The authors present criteria for including measures in pay-for-performance contracts and offer a practical approach to determining withhold return or bonus distribution based on improvement and performance. They demonstrate interventions undertaken to improve performance, including the development of a claims-based registry. Empirical data show that the network performance improved more than the comparable state and national performance during the period of this observational study. The authors conclude that pay-for-performance contracts led to development of medical management programs including a claims-based registry and nonphysician interventions, which helped significantly improve selected HEDIS scores.
本文回顾了一个大型、多样化的综合医疗服务网络的经验，该网络将医生质量指标纳入了按绩效付费合同。作者提出了将指标纳入按绩效付费合同的标准，并提供了一种基于改进和绩效来确定扣留返还或奖金分配的实用方法。他们展示了为提高绩效而采取的干预措施，包括建立一个基于索赔的登记系统。实证数据表明，在这项观察性研究期间，该网络的绩效改善超过了可比的州和国家绩效。作者得出结论，按绩效付费合同促使了包括基于索赔的登记系统和非医生干预措施在内的医疗管理项目的发展，这有助于显著提高选定的医疗保健效果数据和信息集（HEDIS）分数。
