ABSTRACT
The early pay-for-performance (P4P) agreements—Mount Sinai 1977, Health Ways 1978, and CIGNA 1980, along with Medicare’s early 2006 demo projections—all had flaws, as do the current Leapfrog and Bridges concepts. Pay for performance was actually used by health maintenance organizations and some hospitals as early as the mid-1970s when the expansion of capitation created an opportunity for doctors and hospitals to benefit financially by improving effectiveness of care and taking unneeded costs out of the system. One of the first government-sponsored pay-for-performance program demos was the Premier Hospitals project. The P4P incentives have come in several forms, one of which is financial and the other public reporting to consumers as well as health plans in terms of top performers and the public recognition that goes with this. Top performers are identified by calculating composite scores in each measurement domain, which are then weighted according to the recommended P4P payment weights.
