Keeping Score

A comparison of pay-for-performance programs among commercial insurers

It is impossible to improve what cannot be measured or measure what hasn't been defined. Take, for example, the topic of healthcare quality. Everyone wants quality, but everyone's keeping score differently.

A practical approach to improving patient care from the perspective of providers, payers and employers is pay for performance (P4P), which attempts to define, measure and reward quality. P4P has gained traction in US, largely because the Centers for Medicare and Medicaid Services (CMS) has told hospitals and physicians that future increases in payment will be linked to improvements in clinical performance.

Additionally, US commercial health plans are responding to employers demands for quality improvement by developing "scorecards" that use quality metrics to grade care provided by hospitals and physicians.

Keeping Score [PDF 720 KB]