Quality Compensation Programs: Are They Worth All the Hype? A Comparison of Outcomes Within a Medicare Advantage Heart Failure Population

BACKGROUND: Quality compensation programs (QCPs), also known as pay-for-performance programs, are becoming more common within managed care entities. QCPs are believed to yield better patient outcomes, yet the programs lack the evidence needed to support these claims. We evaluated a QCP offered to network primary care physicians (PCPs) within a Medicare managed care plan to determine if a positive correlation between outcomes and the program exists. OBJECTIVE: To compare outcomes of heart failure members under the care of PCPs enrolled in a Medicare Advantage Prescription Drug (MAPD) Plan QCP with those who are not affiliated with a QCP. METHODS: Retrospective analysis was conducted on the heart failure population of a MAPD in Texas. Heart failure members were identified using ICD-9-CM codes from inpatient and outpatient claims for 2010. These members must have been continuously eligible all 12 months of the year to be included in the analysis. The primary intervention was enrollment by the member’s PCP in...