Pay for Performance at the Tipping Point

Abstract

It is hard to dispute the rationale behind realigning payment incentives in health care to encourage higher quality and more efficient care. Indeed, across the country and beyond, the number of “pay for performance” programs, as such realignment is called, has reached a tipping point. In the United States, more than half the health maintenance organizations (HMOs) in the private sector have now initiated such programs, covering more than 80% of the country's HMO enrollees.¹ Congress has mandated that the Center for Medicare and Medicaid Services (CMS) develop plans to introduce a pay-for-performance program into Medicare.² The British have gone . . .