Payers are seeking new ways to bring rapidly increasing health care costs under control. In the past five years, health plans have implemented a variety of programs, the most visible of which have been pay-for-performance, public reporting (PR), consumer-directed health plans (CDHP), and tiering. This paper reviews the emerging concerns about measurement programs generally and specific assessments of the above four types in particular. The authors express considerable concern about the utility of programs focused on judgment (PR, CDHP, and tiering). As an alternative, they encourage the use of programs focused on quality improvement. Judgment-based programs undermine collaboration among stakeholders, making it more difficult to implement the system-wide changes that are needed to significantly improve the value of care. Quality-improvement approaches, tied to incentives and accountability, offer a more constructive model for an effective and efficient health care system.
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