Pioneering Pay-for-Quality: Lessons from the Rewarding Results Demonstrations

This article reports six overarching lessons learned from seven pioneering initiatives in the pay-for-quality (P4Q) movement. These lessons relate to the specific design and implementation challenges sponsors of P4Q programs can expect. The lessons are: (1) P4Q can prioritize providers' quality goals, (2) provider engagement is difficult, (3) P4Q escalates concerns for data accuracy and validity, (4) P4Q increases the need for population-based information technology and infrastructure, (5) tradeoffs exist between stimulating investment in quality infrastructure and diluting the power of incentives for individuals, and (6) significant challenges exist in documenting a positive return on investment.