The Federal nursing home pay-for-performance demonstration had little impact on quality or Medicare spending.

Pay for performance (P4P) aims to use reimbursement to incentivize providers to deliver high‐quality services. This article examines P4P in five Medicaid nursing home programs: Iowa, Minnesota, Oklahoma, Utah, and Vermont. It describes each program and draws lessons regarding program participation, financing, measurement, administration, and development. Findings highlight the importance of obtaining stakeholder input, both initially and on an ongoing basis. Findings also highlight the need to provide opportunities for acceptance and learning by phasing in programs slowly, beginning with performance measurement, followed by public reporting and, finally, by introducing P4P incentives. Funding P4P using new appropriations, incorporating multiple quality measures and domains, and relying on existing data sources when possible were deemed important; so, too, was allowing programs to evolve over time to account for innovations in quality measurement.

Health systems play a critical intermediary role between guideline-developing organizations and practicing clinicians. Strengthening the adoption of guidelines requires attention to many factors beyond care delivery.

BackgroundPublished literature on health care administration, management, and leadership and its impacts on health systems’ programs to address health care inequities is limited, as is information about how organizations integrate health equity in their cultures, missions, and strategic plans.PurposeThe aims of this study were to identify the key components necessary for health systems to implement systematic organizational change to promote health equity and to describe approaches organizations have implemented.Methodology/ApproachWe conducted an environmental scan to identify central principles for implementing lasting change in health systems and experts working to advance health equity through organizational change. We interviewed 19 experts in health equity and hospital executives in 2020. Using iterative thematic analysis, we identified common themes.ResultsConsistent with the literature on organizational change, interviewees described a variety of systematic approaches to change, all of which involve the following core components: (a) committed and engaged leadership; (b) integrated organizational structure; (c) commitment to quality improvement and patient safety; (d) ongoing training and education; (e) effective data collection and analytics; and (f) stakeholder communication, engagement, and collaboration.Conclusion and Practice ImplicationsThere is no “one-size-fits-all” approach to advancing health equity. Decisions about which components require the most attention vary depending on an organization’s internal and external environment. Understanding those environments and identifying which levers will be most effective are essential. As provider organizations strive to develop more strategic and systematic approaches to addressing disparities, long-term vision and commitment are necessary to achieve sustainable organizational change.

Purpose: The creation of the Centers for Medicare & Medicaid Services Office of Minority Health placed increased emphasis on federal efforts to address health disparities. Although the literature establishes a social justice case for addressing health disparities, there is limited evidence of this case being sufficient for businesses to invest in such initiatives. The purpose of this study was to better understand the “business case” behind an organization's investment in health disparity reduction work.Methods: We conducted six case studies (44 on-site interviews) with diverse private-sector provider and payer organizations.Results: While providers and payers cited business rationales for initiating disparity-focused efforts, their motivations differed.Conclusion: As federal entities address health disparities, and payment models shift from volume to value, engaging private stakeholders with the leverage to move the health disparities needle is of principal importance.