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Colorado Pay-for-Performance

Colorado's Pay-for-Performance Program will rely heavily on culture change and quality of life metrics to improve reimbursement. The results of this innovative program will provide a premier opportunity to analyze the outcomes of connecting culture change practice to Medicaid reimbursement.

Jeff Jerebker (President, Pinon Management) on P4P in Colorado: "Our basic costs are not being covered by Medicaid in Colorado. Under this unique P4P system, we can start to fill that reimbursement gap while at the same time move a critical mass of facilities to adopt innovative changes leading to better care and quality of life. We studied other states P4P models but found that most of the performance measures are clinically based. In Colorado, beginning in July 2009, providers can earn up to $4 per day for each Medicaid recipient based on the number of points they achieve using a 0 to 100 scale. What is so unique about our point system is that 70 percent of points a facility can earn are geared to resident quality of life, and a facility must demonstrate that they have implemented specific culture change practices such as enhanced dining programs and consistent assignment. Pay for performance programs will change the behavior of for-profit facilities if the program is designed well and if the profit incentives specifically target those areas where we want change. By focusing so heavily on quality of life and the implementation of certain culture change practices we know that quality outcomes will also improve. There is a link between quality of life in a facility and the clinical outcomes of care."

Excerpt from August 2008 Provider Magazine article, "Investing in Culture Change: Long term care leaders speculate about why it works." Reprinted with permission from Provider Magazine. Access the full article here.