AJMC October 9, 2024
Kailey Love, MBA, MS, Stefanie Turner, MHI, Kailey Love, MBA, MS, Stefanie Turner, MHI, George Runger, PhD, Cameron Adams, MPP, William Riley, PhD

This article explores the congruence between payer patient assignment and quality performance and the implications for incentive payments in alternative payment models.

ABSTRACT

Objectives: To assess the congruence between patient assignment and established patients as well as their association with Healthcare Effectiveness Data and Information Set (HEDIS) quality performance.

Study Design: A retrospective cross-sectional analysis from January 2020 to February 2022.

Methods: The study setting is a fully integrated health care delivery system in Phoenix, Arizona. The study population includes Medicaid patients who received primary care services or were assigned to a primary care physician (PCP) at the study setting by 5 Medicaid managed care organizations (MCOs). We identified 4 possible relationships between the established patients (2 primary care visits)...

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Topics: Patient / Consumer, Payment Models, Provider, Value Based
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