Low Income Health Program Pay-For-Performance

About the Program

Category: Health (Best in Category)

Year: 2013

Quality health care with a focus on improving health outcomes is vital to improving the health of a community. In an effort to improve the overall quality of health and health care for enrollees in San Diego County’s Low Income Health Program (LIHP), the County created a Pay-For-Performance (P4P) value-based payment model. The program encourages providers to meet established goals for health care delivery, and compensates them for meeting specific measurements, including those from the Healthcare Effectiveness Data and Information Set (HEDIS) and the Uniform Data Set (UDS). These tools are used to measure the performance of health care providers on important dimensions of care and service delivery. Other quality indicators utilized in the P4P payment model include availability of mental health services at primary care medical home sites and recognition of health centers as a Patient-Centered Medical Home (PCMH). Since the inception of this program, there has been a 78% improvement in HEDIS measures over baseline, a 34% increase in clinic site activities towards attaining PCMH status, a 53% increase in network adequacy goals, and steady improvement in integrating mental health at community health centers.