America's Health Insurance Plans, Washington, DC, USA.
Health Aff (Millwood). 2013 Aug;32(8):1453-61. doi: 10.1377/hlthaff.2013.0007.
In recent years there has been a significant expansion in the use of provider performance measures for quality improvement, payment, and public reporting. Using data from a survey of health plans, we characterize the use of such performance measures by private payers. We also compare the use of these measures among selected private and public programs. We studied twenty-three health plans with 121 million commercial enrollees--66 percent of the national commercial enrollment. The health plans reported using 546 distinct performance measures. There was much variation in the use of performance measures in both private and public payment and care delivery programs, despite common areas of focus that included cardiovascular conditions, diabetes, and preventive services. We conclude that policy makers and stakeholders who seek less variability in the use of performance measures to increase consistency should balance this goal with the need for flexibility to meet the needs of specific populations and promote innovation.
近年来，提供商绩效措施在质量改进、支付和公共报告方面的使用有了显著的扩展。我们利用一项针对健康计划的调查数据，描述了私人支付者对这类绩效措施的使用情况。我们还比较了一些私人和公共计划中这些措施的使用情况。我们研究了 23 家拥有 1.21 亿商业参保者的健康计划，占全国商业参保者的 66%。这些健康计划报告称使用了 546 种不同的绩效措施。尽管关注的重点包括心血管疾病、糖尿病和预防服务等共同领域，但在私人和公共支付和医疗服务提供计划中，绩效措施的使用存在很大差异。我们的结论是，政策制定者和利益相关者如果希望通过使用绩效措施来提高一致性，减少差异，那么他们应该在实现这一目标的同时，兼顾灵活性，以满足特定人群的需求并促进创新。
