Amending Medicaid: N.H. weighs paying providers for performance.

New Hampshire's Medicaid program is among 15 in the nation that are considering new initiatives for paying physicians and other providers based on the quality of the care they provide where such a protocol does not currently exist, according to a new survey.

"Pay-for-Performance in State Medicaid Programs: A Survey of State Medicaid Directors and Programs," a nationwide survey of state Medicaid programs was released April 12 by nonprofit health analysis firm IPRO Inc. and the New York-based Commonwealth Fund.

The survey found 28 of the nation's Medicaid programs have existing measures providing "financial incentives to health-care providers for quality care," and another 15 states--including New Hampshire--are without one but have similar initiatives under development.

The Medicaid program is a federal- and state-funded program serving individuals and families that meet financial and other eligibility requirements and certain other individuals who lack adequate resources to pay for medical care.

According to the survey, New Hampshire is currently evaluating two pay-for-performance initiatives.

A key component of the GraniteCare program, created in 2004 as part of the state's Medicaid modernization initiative, calls for paying physicians and other practitioners based on performance with financial incentives for prevention, office-based systems and outcomes.

These incentives will result in increased use of practice guidelines, improved patient safety, better clinical outcomes and reductions in medical errors and cost, according to the GraniteCare program outline on the Department of Health and Human Services Web site.

The second program, the New Hampshire's Citizen's Health Initiative, was launched in 2005 as part of a public/private effort to improve health and disease prevention, improve health-care quality, and to promote the openness of information.

Ned Helms, chair of the quality of care policy team for NHCHI, said the workgroup met last year to work on selecting the measures with representatives from Medicaid and the state's major insurers.

He said it was a "good first step" and is planning to have the group reconvene this summer and "continue to move forward."

Of the New England states, only Maine and Rhode Island currently have Medicaid pay-for-performance programs, with Maine proposing an additional program involving all of its state payers. Connecticut and Vermont are both developing two new programs, and Massachusetts is proposing four programs.

A copy of the report may be downloaded at cmwf.org.