Child Development Accounts

Some policymakers have called for the creation of Child Development Account (CDAs).  CDAs are basically savings accounts to which parents and/or the government to contribute.  Children turning 18 can use the funds for various uses such as college tuition, purchasing a home, or starting a businesses. The SEED for Oklahoma Kids (SEED OK) project aims…

VBP Design Choices

“Pay-for-performance (P4P) is one of the primary tools used to support healthcare delivery reform. Substantial heterogeneity exists in the development and implementation of P4P in health care and its effects.” Today, I review a paper which summarizes evidence, obtained from studies published between 1990-2009, concerning P4P effects. Measure Effectiveness Which types of measures produce the…

Physician Performance in Ambulatory Practice

A paper by Holmboe et al. (2010) evaluates physician performance on quality measure.  The authors use a sampled the medical records of an average of 95 patients per general internist.  They found that “performance on the individual and composite measures varied substantially within and between physicians…Higher certification exam scores were associated with better performance on…

Risk Adjustment: Predicting Future Expenditures

Many states rely on managed care organizations (MCOs) to provide medical services for their Medicaid beneficiaries.  Contracting out medical services to private providers relies on the government’s capacity to accurately predict expected cost of care for each beneficiary.  This is typically done through risk-adjusted capitation rates. Which risk adjustment strategy works best?  The answer of…