Can we design effective performance measures that reward teams of providers and integrated groups?
Participants identified the need for performance measures that encourage teams of clinicians to provide coordinated, efficient, and evidence-based care. Research is needed that would examine possible measures of system—rather than individual provider—performance and incentive approaches that can be applied to teams of providers, such as systems of hospitals and other facilities, medical groups, and other groups of clinicians. These incentive approaches would encourage systemness by paying bonuses to more integrated provider groups. Are penalties or rewards more effective? Research to date is not clear as to whether providers are more likely to be motivated by threats such as loss of income or rewards such as cash bonuses. Several pay-for-performance programs, including the CMS Premier Hospital Quality Incentive Demonstration, incorporate penalties for poor performance. More recently, purchasers are exploring new reward mechanisms such as gain sharing, or shared savings, whereby provide
