A Descriptive, Dimensional Model of Pay-for-Performance Incentives

Elizabeth Crabtree, The University of Texas School of Public Health


The growing emphasis on health outcomes, value, and patient-centeredness are currently widely expressed by the “Triple Aim” (Berwick, Nolan, & Whittington, 2008). It refers to the simultaneous pursuit of three aims: improving the experience of care for patients, improving the health of populations, and reducing per capita costs of health care. It has been well-noted that the prevailing healthcare system will not evolve to suit any of these ideals until financial incentives are aligned with a quality-based model. Many efforts are underway to align financial incentives with some or all aspects of the Triple Aim model of quality. A leading strategy in this effort is physician pay-for-performance (P4P). P4P is a physician income strategy that has been developed with the goal of incentivizing quality (IOM, 2006). It is not currently possible to consolidate clear statements regarding how to shape a P4P incentive plan to achieve the desired quality healthcare outcomes. I developed a comprehensive descriptive framework of P4P strategies. The model was identified in a four-step process. The first was to gather and characterize an exhaustive list of types of P4P arrangements. Then, these were analyzed by recognized qualitative analytic methods to develop a coherent dimensional model of P4P strategies. In the third step, recognized experts in P4P implementation and evaluation were asked to review and critique the model. In the fourth step, the model was revised according to expert feedback. The result is an empirically-derived, expert-validated dimensional model of P4P arrangements. This framework could guide assessment of the degree that any specific P4P incentive plan is acceptable to providers, and the degree that any incentive plan might be adopted by policies, standards, and payers. Ultimately, it might contribute to the growing trend to incentivize healthcare delivery to be more value-oriented and achieve Triple Aim results.

Subject Area

Public health|Health care management

Recommended Citation

Crabtree, Elizabeth, "A Descriptive, Dimensional Model of Pay-for-Performance Incentives" (2017). Texas Medical Center Dissertations (via ProQuest). AAI10604071.