Pay for Performance Program

Promoting Quality Improvement, Accountability and Affordability

As part of its ongoing commitment to promote access to high quality care, Blue Shield of California has been participating in an initiative sponsored by the Integrated Healthcare Association (IHA) to implement a uniform incentive program for California independent physician associations and medical groups.

The Pay for Performance (P4P) program rewards physician practices and medical groups with financial incentives based on select performance measures. These performance measures cover various aspects of healthcare delivery including clinical quality and safety, patient experience, and use of information technology, all of which help to support a high level of patient care for Californians.

Since 2003, Blue Shield has awarded more than $98 million to providers through its P4P program and has seen positive improvements in quality care for its members. “Paying for performance allows us to encourage best practices to achieve breakthroughs in clinical quality, increase member satisfaction, and control the rising cost of health care,” said Juan Davila, senior vice president, network management.

According to the IHA, early lessons have revealed that P4P programs can engage providers and change behavior. Each health plan determines its own budget and methodology for calculating and distributing payments to physician organizations. There are eight health plans participating in this program with IHA in California.

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