Which of the following is not a condition that has to be met when using individual incentives?

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Page 2

Which of the following is not a condition that has to be met when using individual incentives?

The European Journal of Health Economics

Conclusions with respect to P4P-program design

What to incentivize

Performance is ideally defined broadly, provided that the set of measures remains comprehensible

Concerns that P4P encourages “risk selection” and “teaching to the test” should not be dismissed

Outcome and resource use measures should be included provided that risk adjustment is sophisticated and sample size is sufficient. Other strategies to minimize incentives for risk selection may still be necessary

Measure sets should at least incorporate “high-impact” measures; the more indeterminate aspects of care such as patient satisfaction and continuity of care are ideally also included or monitored

P4P incentives should be aligned with professional norms and values; it is vital that providers are actively involved in program design and in the selection of performance measures

Monitoring, structured feedback, and sophisticated information technology will remain important in preventing undesired provider behavior

Whom to incentivize

On balance, group incentives are preferred over individual incentives, mainly because performance profiles are then more likely to be reliable

Individual or small-group incentives as well as using measures with small sample size will become increasingly feasible as methods for constructing composite scores evolve

Caution should be upheld in applying hybrid schemes

Participation is ideally voluntary provided that broad participation among eligible providers can be realized

How to incentivize

Whether rewards or penalties should be used is context-dependent. Offering providers a choice among schemes also including penalties may be considered

Increasing the size of the incentive increases their strength up to a certain point. Yet, relatively low-powered payments are preferred, provided that providers’ costs of improving performance are covered

Differentiated absolute targets across groups and/or a tiered series of absolute targets, possibly combined with additional “piece-rates” for each appropriately managed patient, are preferred over single targets and schemes using relative targets

The time lag between care delivery and payment should be minimized

P4P should be a permanent component of compensation and is ideally decoupled from base payments. Measures should be reevaluated periodically and be replaced or updated as necessary