RESUMEN
A health care coalition in Maine has piloted a performance-based incentive payment program that creates a single statewide program, based on common standards. Incentive payments were funded by a hospital's financial guarantee that was matched by employers. A two-step incentive allocation methodology differentiates adequate and superior performance. The incentive model is sufficiently flexible to accommodate different settings and evolving performance standards. This case study provides useful insights to payers and hospitals that are considering similar regional initiatives, emphasizing the collaborative context that underscored this venture.
Asunto(s)
Administración Financiera de Hospitales/organización & administración , Desarrollo de Programa/métodos , Reembolso de Incentivo/organización & administración , Humanos , Maine , Estudios de Casos Organizacionales , Evaluación de Procesos y Resultados en Atención de Salud/métodos , Proyectos PilotoRESUMEN
In response to continuing concerns about escalating health care costs and poor quality care, many health plans have adopted a strategy called "tiered provider networks." With TPNs, plans provide financial incentives for members to utilize hospitals, primary care physicians, and/or specialist physicians identified as performing especially well in terms of cost-efficient and/or high-quality care. The strategy is relatively new, and little is known about TPN structure, implementation, or operation. In this article, we present findings about tiered provider networks developed from a national survey of health plans and from interviews with health plan executives, their employer clients, and providers in their networks.