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Rural Hospital and Physician Participation in Private Sector Quality Initiatives

Diehl, A.; Casey, M.; Evenson, A.

The purpose of this project is to analyze private sector quality reporting and quality improvement initiatives being implemented by dominant insurers in states with significant rural populations. 

The policy brief profiles twelve quality initiatives (six focusing on physicans, six focusing on hospitals) sponsored by private sector payers in six different states.

Key Findings:

  • In six states with significant rural populations, private insurers are implementing initiatives designed to improve the quality and efficiency of care provided by physicians and hospitals.
  • These insurers’ motivations included employer requests for fee-for-value hospital contracting, and desires for increased efficiency and to align incentives with national quality standards.
  • Participation is voluntary in the majority of programs. Eleven of the twelve programs provide direct financial incentives to providers.
  • These initiatives use a wide range of quality measures, including Centers for Medicare and Medicaid Services (CMS) and National Committee for Quality Assurance (NCQA) measures, as well as measures developed for state and local initiatives and hospital networks.
  • Although the majority of these initiatives do not specifically address rural providers, one hospital program and two physician programs do.
  • Limited data are publicly available on the impact of these initiatives on rural hospitals, physicians, or consumers.

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