Pay for Performance

Pay for performance (“P4P”) is an arrangement of payment in health insurance under which providers are rewarded for meeting pre-established goals for efficient delivery of health care service. Often, payers employ this payment model as a financial incentive for physicians and other health care providers to reach certain measures of increased quality or decreased cost. A number of P4P programs have been developed by both public and private insurers including the Centers for Medicare and Medicaid Services’ (CMS) Physician Quality Reporting Initiative and eRx incentive programs.

Resources

AHRQ resources on pay for performance (P4P) (ahrq.gov)

Aetna’s P4P program (aetna.com)

CMS Physician Quality Reporting Initiative (PQRI) (cms.hhs.gov)

CMS Electronic Prescribing (eRx) Incentive Program (cms.hhs.gov)

PQRI quality measures (cms.hhs.gov)