Provider Performance Measures In Private and Public Programs: Achieving Meaningful Alignment With Flexibility To Innovate

In recent years there has been a significant expansion in the use of provider performance measures for quality improvement, payment, and public reporting. Using data from a survey of health plans, this study characterizes the use of such performance measures by private payers, and also compares the use of these measures among selected private and public programs. Twenty-three health plans with 121 million commercial enrollees, representing 66 percent of the national commercial enrollment, were studied. The authors found that there was much variation in the use of performance measures in both private and public payment and care delivery programs, despite common areas of focus that included cardiovascular conditions, diabetes, and preventive services.