Original ArticlePay-for-Performance in the Massachusetts Medicaid Delivery System Transformation InitiativeSefton, Laura; Tierney, Laxmi Author Information For more information on this article, contact Laura Sefton at [email protected]med.edu. The authors have no conflicts of interest to declare. Evaluation of DSTI was part of a larger evaluation of the 1115 Demonstration Waiver that was financed by the state's Office of Medicaid (See https://www.medicaid.gov/Medicaid-CHIP-Program-Information/By-Topics/Waivers/1115/downloads/ma/MassHealth/ma-masshealth-cms-apprvd-demo-period-final-2014-2017-09252019.pdf). Journal for Healthcare Quality 45(1):p 38-50, January/February 2023. | DOI: 10.1097/JHQ.0000000000000357 Buy Metrics Abstract Pay-for-performance (P4P) is among the alternative payment models (APMs) that are designed to incentivize enhancements to healthcare efficiency and quality. Massachusetts' Office of Medicaid implemented a delivery system transformation initiative (DSTI) through an 1115(a) Demonstration Waiver to support and incentivize seven safety net hospitals to implement clinical care changes and transition to risk-based APMs. Comparative case study design was used to describe achievement of hospital-specific clinical and operational measures. Qualifying hospitals implemented 47 projects across three categories: (1) development of a fully integrated delivery system, (2) health outcomes and quality, and (3) ability to respond to statewide transformation to value-based purchasing and to accept alternatives to fee-for-service payments that promote system sustainability. Projects commonly focused on care transitions improvements, physical and behavioral healthcare integration, and chronic disease care management interventions. Collectively, the hospitals met all or most of 60 population-focused improvement measures and 10 common measures' targets, indicative of the progress. Some hospitals achieved substantial positive gains; however, missed targets suggest substantial organizational and workflow changes over a longer timeframe as well as consistent patient engagement may be necessary. Overall, the P4P structure of DSTI was effective in encouraging organizational change and supporting the transition of these hospitals towards APMs. © 2022 National Association for Healthcare Quality
