Improving timely childhood immunizations through pay for performance in Medicaid-managed care.
OBJECTIVE
To evaluate the impact of a "piece-rate" pay-for-performance (P4P) program aimed at rewarding up-to-date immunization delivery to 2-year-olds according to the recommended series.


METHODS
Plan-level data from New York State's Quality Assurance Reporting Requirement and claims data from Hudson Health Plan for 2003-2007. In 2003 Hudson Health Plan, a not-for-profit Medicaid-focused managed care plan, introduced a U.S.$200 bonus payment for each fully immunized 2-year-old and provided administrative supports for identifying children who may need immunization. This represented a potential bonus of 15-25 percent above base reimbursement for eligible 2-year-olds.


METHODS
Case-comparison and interrupted times series.


RESULTS
Immunization rates within Hudson Health Plan rose at a significantly, albeit modestly, higher rate than the robust secular trend noted among comparison health plans. Supplementary analyses suggest that there was no significant change in preexisting disparities during the study period, and that children with chronic conditions have significantly greater odds of being fully immunized during the entire study period.


CONCLUSIONS
This study suggests that a piece-rate P4P program with appropriate administrative supports can be effective at improving childhood immunization rates.
Chien
Alyna T
AT
Division of General Pediatrics, Children's Hospital Boston, 21 Autumn Street-Room 223, Boston, MA 02115, USA. alyna.chien@childrens.harvard.edu
Li
Zhonghe
Z
Rosenthal
Meredith B
MB
D006801:Humans; D007114:Immunization / Q000706:statistics & numerical data*; D007223:Infant; D008329:Managed Care Programs / Q000191:economics / Q000458:organization & administration* / Q000706:statistics & numerical data; D008484:Medicaid / Q000191:economics / Q000458:organization & administration* / Q000706:statistics & numerical data; D009518:New York; D010818:Practice Patterns, Physicians' / Q000191:economics / Q000458:organization & administration* / Q000706:statistics & numerical data; D019984:Quality Indicators, Health Care; D011787:Quality of Health Care / Q000191:economics / Q000458:organization & administration* / Q000706:statistics & numerical data; D012052:Reimbursement, Incentive / Q000191:economics / Q000458:organization & administration* / Q000706:statistics & numerical data; D012959:Socioeconomic Factors; D014481:United States