Reference no: EM132802771

Case analysis

As more and more payers focus on measuring and rewarding performance, issues arise about how to use that process to motivate continuous quality improvement. The National Health Services has had the world's largest implementation of pay-for-performance. General practitioners have responded rapidly to the incentives, driving most values rapidly toward their maxima. This case considers how the UK has addressed this "now what" question. This is a political environment, so the pacing and the apparent fairness and rationality of the process for continually raising the bar are very important to continued success.

1. What do you consider to be the key issues for quality improvement in the National health services quality improvement program as it goes forward?
2. What do you consider to be the strengths and weaknesses of the effort to improve the development of Quality and Outcomes Framework indicators over the next couple of years?
3. The program appears to be using QALY metrics to justify the choices of future quality and outcome indicators. What are the strengths and weaknesses of such an approach to valuing quality?
4. Some researchers have expressed doubts about the improvement effectiveness of indicators in the high 90% range. What is your evaluation of this concern and what alternatives do you recommend?
5. Most U.S. P4P efforts do not allow for exclusion of a significant numbers of patients. What are the pros and cons of this approach and the one used by National Health Services?
6. National Health Services is a single payer system. How does this affect its design of the QOF system and its efforts to implement it? How do the much more complex U.S. payment systems affect its utilization of P4P systems?
7. The National Health Services Quality and Outcome Framework effort is obviously full of very specific point systems for evaluation. What are teh strengths and weaknesses of such quantification of decision rules in a healthcare environment?