Abstract
Background/Aim: Concerns about the quality of care delivered in the U.S. health care system gained national momentum with the release of the Institute of Medicine’s reports To Err is Human: Building a Safer Health System and Crossing the Quality Chasm, which revealed that patients were not receiving the quality or level of care that they needed and called for fundamental change to the health care system. To address this need, health plans across the country have used varying approaches to support quality improvement (QI)—pay-for-performance (P4P) being the most commonly used and discussed approach. However, P4P programs also have many challenges in design and execution, particularly for Medicaid providers. In order to find an alternative that overcame the challenges of P4P, CareOregon—a non-profit health plan serving Medicaid and Medicare enrollees in Oregon—developed the Care Support and System Innovation (CSSI) Program. An evaluation was conducted to assess the overall impact of the CSSI program in promoting comprehensive improvements in quality of care among network providers and the extent to which it offers a viable alternative to P4P.
Methods: Data were collected from the 48 medical practices that participated in the CSSI Program between 2005 and 2007. Data collection strategies included site visits, telephone interviews, document review and a web-based survey. Qualitative data were coded and analyzed using a grounded theory approach, emphasizing identification of themes judged meaningful to the study subjects. Quantitative data were analyzed through the use of descriptive statistics and chi-squared analysis.
Results: The evaluation found that the CSSI Program successfully addressed many challenges inherent in P4P. The CSSI Program successfully engaged providers, fostered a culture of quality improvement within its provider network, and provided practices with the opportunity to develop sustainable and innovative solutions to address quality concerns. Success of the program was attributed to CareOregon’s focus on building relationships while providing technical assistance and responsive funding.
Conclusions: The CSSI Program has provided valuable support for improving quality of health care delivery and encouraged innovation among participating providers. The model provides a viable alternative for overcoming many of the challenges faced by pay-for-performance and other quality improvement programs.
- Quality of health care delivery
- Care Support and System Innovation Program
- Quality improvement assessments
- Received May 27, 2010.
- Accepted May 27, 2010.
