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Pay for Performance

UMass Medical School’s Center for Health Policy and Research has been working with MassHealth, the state’s Medicaid program, to develop and implement pay-for-performance programs for primary care physicians and nursing facilities. Pay-for-performance programs are a growing trend among Medicaid programs nationwide, linking quality and efficiency to reimbursement rates. The guiding principle is to reward providers who exceed benchmarks or improve their performance.

The MassHealth Pay-for-Performance Initiative was established as part of the state’s 2006 health care reform measures.

Our work in the project includes:

  • Establishing the goals and values of the program,
  • Evaluating and selecting clinical measures,
  • Designing practice infrastructure and facility processes surveys,
  • Establishing benchmarks,
  • Determining a process to measure improvement, and
  • Designing a payment methodology.

For the MassHealth Primary Care Clinician (PCC) Plan, the program relies on Healthcare Effectiveness Data and Information Set (HEDIS) indicators, which are already collected and reported to primary care clinicians by the PCC Plan. The program also relies on a practice infrastructure survey designed to reward PCCs for infrastructure characteristics that are linked to good quality of care.

A separate pay-for-performance program is being developed for nursing facilities, and the Center for Health Policy and Research is working with the MassHealth Office of Long Term Care to design a program that that rewards facilities for having specific facility processes and for performance on a set of clinical indicators.

Key Staff

Ann Lawthers  Ann Lawthers, S.M., Sc.D.
Senior Director, Evaluation and Measurement, and Director, Clinical Policy and Projects

Learn More

David Tringali
(617) 210-5423