Pay-for-performance in State Medicaid Programs a Survey of State Medicaid Directors

Many health care purchasers are trying to link health care spending to quality and efficiency through pay-for-performance (P4P) programs. This report examines the current and planned P4P activities of state Medicaid programs, based on a survey and follow-up interviews with state Medicaid directors and their staffs as well as review of related documents. The authors found that more than half of states currently operate one or more pay-for-performance programs and nearly 85 percent expect to do so within the next five years. Health information technology is an important component of programs now in development. The report outlines the most common measures and incentives, discusses evaluation and reporting approaches, and provides detailed descriptions of each of the pay-for-performance programs. The findings should inform state governments and other stakeholders that are considering modifying or adopting pay-forperformance strategies. Support for this research was provided by IPRO, a not-for-profit quality assessment and improvement organization based in Lake Success, N.Y. The views presented here are those of the authors and not necessarily those of The Commonwealth Fund or its directors, officers, or staff. This and other Fund publications are available online at www.cmwf.org. To learn more about new publications when they become available, visit the Fund’s Web site and register to receive e-mail alerts. Commonwealth Fund pub. no. 1018.