Paying For Performance In Primary Care: Potential Impact On Practices And Disparities

Performance-based payments are increasingly common in primary care. However, given the persistent disparities in the quality of care that different populations receive, such payments may actually take resources away from the care of racial and ethnic minorities and people of low socioeconomic status. RAND investigators simulated performance-based payments to practices serving higher and lower shares of patients from these vulnerable communities in Massachusetts. Typical practices serving higher shares of vulnerable populations would receive less per practice compared to others, by amounts of more than $7,000. These findings suggest that pay-for-performance programs should monitor and address the potential impact of performance-based payments on health care disparities.