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More States Planning Medicaid Pay-for-Performance Plans

Pay-for-performance initiatives expected in most states within five years

THURSDAY, April 12 (HealthDay News) -- More than half of U.S. state Medicaid programs have pay-for-performance plans, a proportion expected to increase to 85 percent in five years, according to a report published by The Commonwealth Fund. Some states may offer greater reimbursement to providers because of concerns that such programs will cause physicians to limit or exclude Medicaid patients.

Thomas Hartman, a vice president of IPRO, a non-profit Lake Success, N.Y. group, and Kathryn Kuhmerker, president of The Kuhmerker Consulting Group, LLC, in Niskayuna, N.Y., surveyed all state Medicaid directors in 2006 about their pay-for-performance plans.

Most states had pay-for-performance programs planned, including several joining regional efforts. Many such programs focus on health information technology, electronic prescriptions and health record use. Some 70 percent of Medicaid pay-for-performance programs now involve preventive care for children, adolescents and women, the researchers found. But access to health care remains a challenge.

"Several Medicaid directors were concerned that pay-for-performance activities might impinge upon beneficiaries' access to care by causing providers to leave the Medicaid program or limit the number of Medicaid beneficiaries served in their practices," according to the report. "This concern is shaping some of the approaches taken in pay-for-performance programs, particularly in states with large rural or sparsely populated areas."

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