Incentives and Choice Architecture: Designing Experiments to Improve Health Care Quality

Managed Care Organizations (MCOs) cover about 80% of California’s 12 million Medicaid enrollees. Medicaid MCOs can earn millions of dollars in federal waiver funds through a pay-for-performance system called the Quality Incentive Pool (QIP). Even so, QIP performance is uneven and quality remains low. In addition, health systems worry about physician burnout and patient satisfaction from the proliferation of checklists associated with the QIP. In this pilot, we will work with Contra Costa Health Services, a large public MCO and health system in California, to develop interventions to improve QIP performance and provider and patient experience. Our pilot aims to understand the QIP program and the system’s performance, determine where performance can be meaningfully improved, and develop testable interventions to do so. By the end of this pilot, we will have designed randomized controlled trials to test the interventions identified as promising for improving QIP performance.