Background: Recently, health plans have initiated pay-for-performance (P4P) programs to incentivize pharmacies to focus on medication-related quality measures. Little research exists as to what attributes help a pharmacy to perform well in a P4P program. Objectives: This study aimed to: (1) propose a conceptual framework evolved from theories pertaining to economic, psychology, and organizational behavior disciplines that may contribute to a pharmacy's performance in a financial incentive program; (2) develop theoretically-derived questionnaires designed to elicit from pharmacists and pharmacy management pharmacy characteristics and pharmacy personnel factors thought to be associated with achieving quality measures specified for a pharmacy P4P program; (3) psychometrically assess these two newly developed questionnaires designed to collect information from community pharmacies eligible to participate in a pharmacy P4P program; (4) assess the magnitude of the relationship between pharmacy-related and construct redundancy of latent variables identified in objective 3; and (5) examine pharmacy factors' association with community pharmacies achieving quality measures in a pharmacy P4P program. Methods: Two survey instruments were created from a theoretically-derived conceptual framework to measure pertinent pharmacy characteristics and pharmacy personnel factors using a multi-step, mixed-methods process. Questionnaire development entailed semi-structured interviews, item generation, expert content validation, and cognitive debriefings. Developed questionnaires were evaluated in a non-experimental, cross-sectional survey of pharmacists and pharmacy management. Pharmacy personnel surveyed for this study were affiliated with pharmacies in Inland Empire Health Plan's (IEHP's) community pharmacy network. Using items measured in each questionnaire, specified groups of items were hypothesized to have a certain underlying latent variable. Latent variables hypothesized for items measured in the pharmacist questionnaire included: (1)"adherence management -services," (2)"adherence management-counseling," (3) "asthma management," (4) "pharmacist-prescriber relationship," (5) "chronic disease management," (6) "non-dispensing ability," and (7) "workload impact". For items measured in the pharmacy management questionnaire, eight latent variables were hypothesized: (1) "program understanding," (2) "program financial salience," (3) "program involvement," (4) "organization's adaptability," (5) "organization's innovativeness," (6) "organization's proactiveness," (7) "organization's risk-taking." and (8) "organization's focal emphasis." For hypothesized latent variables with four or more items, the value thresholds of three assessment indexes were employed as criteria to evaluate each measurement model's goodness-of-fit. Indexes included: (1) 2 test statistic (i.e.,>0.05), (2) root mean square error of approximation (RMSEA) (i.e., 0.05), and (3) comparative fit index (CFI) (i.e.,>0.95). The statistical significance of item factor loadings was assessed for latent variables with (1) four or more items deemed to have adequate model fit per index criteria and (2) only three items, for which goodness-of-fit may not be assessed. Structural modeling was used to explore associations between (1) pairs of latent variables with adequate model fit and/or statistically significant factor loadings; and (2) latent variables with medication-related quality measures. The strength of associations among latent variable pairs was measured with correlation coefficients. Latent variable pairs with significant correlations greater than 0.50 were evaluated for construct redundancy, for which a change in CFI was used as the comparison criteria to determine whether the latent variables are better represented as one (i.e., (CFI<-0.01) or two constructs (i.e., (CFI ≥ -0.01). Mediation-related quality measures specified as dependent variables in structural models included: diabetes medication adherence, hypertension medication adherence, hypercholesterolemia medication adherence, absence of controller therapy in patients with asthma, use of high-risk medications in elderly, and generic dispensing rate. Results: The empirically derived conceptual framework outlined four major domains proposed for consideration when evaluating pharmacy P4P programs: (1) incentive; (2) pharmacy; (3) other influencing factors; and (4) P4P program measures. From this framework, two questionnaires were developed with the aim of measuring pharmacists' and pharmacy management's pharmacy attitudes and perspectives of a community pharmacy P4P program. The pharmacist survey instrument consisted of five sections: (i) community pharmacy P4P program; (ii) pharmacy services; (iii) pharmacist workload; (iv) pharmacy practice site; and (v) pharmacist's background. The pharmacy management questionnaire consisted of four sections: (i) pharmacy P4P program; (ii) pharmacy organization's characteristics; (iii) pharmacy practice site; and (iv) respondent's background information. Among the 604 pharmacies invited to participate, pharmacists from 114 unique pharmacies (19%) and pharmacy management from 100 unique pharmacies (17%) participated in the survey. This study identified psychometrically validated measurement models for latent constructs with items measured in the pharmacist ("adherence management-counseling," "asthma management," "workload impact" ) and pharmacy management ("program involvement," "organization's innovativeness," "organization's proactiveness," "organization's risk-taking" ) questionnaires). With the exception of "program involvement," the latent constructs measured in the pharmacy management questionnaire were identified to be significantly correlated (𝛹>0.50, p<0.001) and more parsimoniously represented as one factor rather than two (∆CFI<-0.01). No significant associations were identified in exploratory analyses of validated measurement models from the pharmacist questionnaire with targeted medication-related quality measures in IEHP's community pharmacy P4P program. Conclusion: This study collected data for two questionnaires evaluating (1) pharmaceutical care services conceptualized to be associated with targeting medication-related quality measures and (2) pharmacy management's attitudes toward a pharmacy P4P program. Furthermore, psychometric assessment of each questionnaire supplied initial validity evidence for three constructs for the pharmacist questionnaire ("adherence management-counseling," "asthma management," and "workload impact" ) and four constructs for the pharmacy management questionnaire ("program involvement," "organization's innovativeness," "organization's proactiveness," and "organization's risk-taking" ). Subsequent validation of these latent constructs in larger sample sizes is required. Continued study of pharmacy factors and their association with medication-related quality measures is needed to improve our understanding of pharmacies' performance in financial incentive programs. As pharmacy organizations are increasingly integrated into more financial incentive programs aimed at targeting process- and outcomes-related quality measures, it is essential to be able to measure pharmacy and management factors in order to determine which factor(s) impact pharmacy performance.

Thesis advisor: Julie Mortimer / Essays on the effects of health policy payment systems in long-term care and end-of-life care institutions are studied. In the arena of long-term care, state Medicaid agencies have recently implemented pay-for-performance (P4P) programs to address poor quality of care in nursing homes. Using facility-quarter level data from 2003 to 2010, we evaluate the effects of Medicaid nursing home P4P programs on clinical quality measures, relying on variation in the timing of P4P implementation across states. Further, we exploit variation in the structure of states' programs to investigate whether programs that reward certain dimensions of quality are associated with larger improvements. We find P4P decreases the incidence of adverse clinical outcomes by as much as 8%, and the improvements are concentrated among the measures that experienced an increase in their relative returns and share strong commonalities in production. In the Hospice industry, changes to the current reimbursement system are mandated by the Patient Protection and Affordable Care Act. The motivation stems from noticeable hospice utilization changes since the Medicare Hospice Benefit (MHB) introduced a per-diem reimbursement in 1983. This research analyzes the abilities of a multi-tiered payment system, and a simpler two-part pricing system, to accurately match Medicare payments with hospice patient costs. Both systems improve on the current payment mechanism, while two-part pricing is the only system to maintain access to care for all MHB eligible patients. In addition, consumer disutility incurred by driving to airports is estimated and used to define air travel markets. Though an accurate definition of an economic market is important for any study of industry, there is no rule governing what exactly constitutes a market. To define a market we must ask the question ``between which products do consumers substitute,'' knowing that the answer to this question will depend on how ``close'' products are to one another in product space, as well as how close they are to one another, and to consumers, in geographic space. We estimate a discrete choice model of air travel demand that uses known information about the locations of products and consumers, which allows us to study substitution patterns among air travel products at different airports. We evaluate the commonly used city-pair and airport-pair definitions of a market for air travel, and conclude that a city-pair is the appropriate definition. We also employ the Hypothetical Monopolist test for antitrust market definition, as defined by the Department of Justice and Federal Trade Commission, and conclude that the relevant geographic market for antitrust analysis is frequently more narrowly defined as an airport-pair. / Thesis (PhD) — Boston College, 2013. / Submitted to: Boston College. Graduate School of Arts and Sciences. / Discipline: Economics.

The Hospital Value-Based Purchasing Program (HVBP), created by Section 3001 of the Patient Protection and Affordable Care Act passed in 2010, enacted a major industry shift in Medicare towards "pay for performance," or paying for high marks on a variety quality metrics rather than the traditional reliance on volume of care delivered. This study examines one of these quality metrics in particular: patient satisfaction. The trajectory of this paper begins with an overview of the current focus on patient satisfaction as a modern quality metric in American healthcare, contextualizes this emphasis on satisfaction within the intellectual movement of "patient-centered care," and moves on to a review of the relevant scholarship that attempts to explain the numerous determinants of patient satisfaction scores (with special attention to the inpatient hospital setting), as well as the robust academic debate over whether satisfaction is even an appropriate quality metric at all relative to clinical outcomes in care. The second half of my discourse moves on to more practical applications - first I break down the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey and the impact of its methodology on providers, then the Medicare HVBP program itself and its various directions towards the value-based care model. I conclude with a quantitative analysis of trends in patient satisfaction over time between 1) HVBP-participating providers (as of FY2014) and 2) those providers who have not opted in (including those ineligible to do so). My comparison aims to study the strength of the HVBP incentives to improve patient satisfaction in those subject to the financial incentive relative to those who are not. Additionally, I preface this analysis whether patient satisfaction scores are associated with either clinical process of care scores or outcome scores in the HVBP program. My research questions aim to shed light on the academic debate between patient satisfaction and more traditional clinical outcomes - are they related in the context of FY2014 HVBP? Are the new incentives to improve patient satisfaction actually doing so in a meaningful way among providers newly accountable to these incentives? Finally, in a market defined by zero-sum resources, is there evidence that a financial incentives around patient satisfaction are channeling resources and by extension improvement away from clinical outcome performance? I believe this last question is the true concern of patient satisfaction skeptics, and hope to address it with applicable data. By providing a thorough qualitative grounding in the topic followed by current quantitative analysis, my goal is to create an informed perspective on the use of patient satisfaction as a quality metric in U.S. healthcare, which can be applied meaningfully from policy, provider, and consumer vantage points. With patient satisfaction becoming increasingly more internalized in the value-based care model, these analyses of the initial results in HVBP potentially serve as predictive insight into provider behavior in this area moving forward.

There is a growing demand for accountability of nonprofit organizations, and nonprofit business leaders are increasingly under pressure to demonstrate operational effectiveness. The problem is that some business leaders of nonprofit organizations lack strategies for identifying and selecting actionable performance measures of operational effectiveness. Using the plan-do-study-act conceptual framework, this single case study of a nonprofit organization located in the mid-Atlantic region of United States was conducted to explore strategies that 3 of its business leaders used to identify and select actionable performance measures of operational effectiveness. Using thematic analysis of data collected from semistructured interviews, documents, and public sources, emergent themes included: (a) usefulness of measures, (b) customer experience, and (c) workforce education. The findings of this study may have implications for social change by helping nonprofit business leaders achieve consensus on measures of effectiveness beyond financial measures. Additionally, the findings could support the usefulness of transparency in reporting performance outcomes, encourage a shift in focus from program spending and ratios to effectiveness, and prompt external stakeholders to expect performance measures that demonstrate effectiveness in nonprofit program operations.

Objective: The primary objective of this study was to examine the relationship between hospital structural characteristics and penalization status (penalized or not penalized) in any given hospital acquired condition (HAC) Reduction Program year, FY 2015 through 2018. Structural characteristics included hospital type, case mix index, average daily census, bed size, ownership, disproportionate share percentage, location, and American Nurses Credentialing Center Magnet status. The secondary objective of the study was to determine whether a hospital's penalization status across one or more HAC Reduction Program years is related to quality performance (Total HAC Score) in subsequent years. These objectives were achieved through retrospective, longitudinal, multivariate regression analysis using 4 publicly available data sources. Background: The intention of pay-for-performance programs, including the Centers for Medicare and Medicaid HAC Reduction Program, is to improve the quality of care delivered; however, the theoretical and conceptual basis of pay-for-performance programs and their efficacy in improving care are widely debated. This study was designed to address the gap in knowledge related to the efficacy of value-based reimbursement as a means of motivating providers and organizations to improve healthcare quality. Results: Higher average daily census, disproportionate share percentage, and case mix index were associated with increased likelihood of receiving a penalty in the HAC Reduction Program. Approximately half (49%) of who did not experience a penalty at all improved their Total HAC Score. 51% of hospitals with 1 year of penalty improved their Total HAC Score; 54% of hospitals with 2 years of penalty improved their Total HAC Score; 73% of hospitals with 3 years of penalty improved their Total HAC Score. Conclusions: Despite the inability of some hospitals to meet the benchmark to avoid penalty, the vast majority of hospitals improved their performance over time. This finding holds promise for value-based reimbursement as a means for improving HAC incidence.

<p>Problem</p><p>Performance management på individnivå innebär att styra individen utifrån individuella mål som förmedlar organisationens övergripande strategi till medarbetarna. För att förstärka styreffekterna av individuella mål kan en belöning kopplas till måluppfyllelsegrad. Effekten av ett bonussystem ställer stora krav på samarbete mellan chef och anställd då de tillsammans ska ställa upp realistiska mål som syftar till att utveckla den enskilde individen samtidigt som de bidrar till organisationens övergripande mål och resultat. Därmed är det viktigt att undersöka hur medarbetare och chefer påverkas av individuella mål kopplade till bonus och vilka effekter detta får inom företaget. Vilken effekt har målsättnings-, uppföljnings- och utvärderingsarbetet på styrning och motivation bland medarbetare och chefer?</p><p>Syfte</p><p>Syftet är att undersöka och öka förståelsen kring hur styrning och motivations-aspekter påverkas då performance management bryts ner till individnivå samt hur en belöningskoppling kan förstärka den eventuella styreffekten.</p><p>Metod</p><p>Undersökningen har genomförts i form av en fallstudie där intervjuer använts som främsta empiriinsamlingsmetod. Intervjuverktyget valdes för att få en förståelse för hur performance management påverkar personer inom en organisation utifrån ett styr- och motivations-perspektiv. Det gav möjlighet till att undersöka problemet på en djupare nivå där olika synsätt och åsikter kring ämnet kunde fångas upp under personliga intervjuer.</p><p>Resultat</p><p>Undersökningen visar att styrfilosofin inom en organisation inte påverkas i nämnvärd utsträckning av performance management på individnivå. Det som påverkas är hur organisationen väljer att hantera styrningen i form av de svårigheter som uppstår i och med att målen blir individuella. De största svårigheterna med ett individuellt målsättningsprogram är att få en jämvikt mellan finansiella och ickefinansiella mätetal där målen kommuniceras och förankras hos medarbetarna på ett fungerande sätt. Trots att de mjuka målen uppfattas som oerhört viktiga på individnivå så är det dessa mål som skapar de största svårigheterna. Fallstudien har visat att en tydlig målsättning med konkreta och realistiska mål är en förutsättning för att påverka styrningen i positiv riktning. Det framgår även att rättvisa är viktigt i och med att en bonus kopplas till måluppfyllelsegrad varför kvalitén på målsättningsarbete och uppföljningen är av stor vikt.</p> / <p>Problem</p><p>Performance management helps the organisation clarify the strategy through individual targets. To reinforce the management effect a bonus can be connected to the fulfilment of targets. When a bonus is connected to performance management it is vital that the communication between managers and co-workers is well functioning and that the individual targets support the co-workers learning as well as they support the organizations overall targets. Therefore it is important to investigate how co-workers and managers are affected by individual targets and what consequences it has on the organization. What impact has the target setting-, follow up- and evaluation process on the organisation’s management and the motivation among the staff?</p><p>Purpose</p><p>The purpose of this study is to investigate and increase the understanding of how management and motivational aspects is affected when performance management is broken down to individual levels and how a reward can enhance the possible control effect.</p><p>Method</p><p>This study has been performed through a case study where interviews have been the primary method. Several interviews were conducted to gain an understanding of how performance management influences employees in an organization on the basis of a control and motivational aspect. Interviews made it possible to examine the purpose on a deeper level, where different opinions and approaches to performance management could be collected.</p><p>Result</p><p>The control function is not influenced by the fact that performance management is broken down to individual levels. The difficulty with this topic is the problems that arise when targets are made individualized. Individual targets make it hard to find a balance between financial and non-financial measurements and to gain the approval of employees. Non-financial goals cause the biggest problems since these are the hardest goals to measure and reward. Despite problems surrounding the non-financial goals there exist a great confidence in such goals. The case study shows that performance management on an individual level demands a well functioning communication to effect organisational management in a positive direction. It also shows that a bonus connected to targets demands a high quality in the rewarding procedure where justice plays an important part.</p>

No description available.

The culminating recommendations of the United States Secretary of Education, Margaret Spellings’ 2006 Commission on the Future of Higher Education report demand greater access, affordability, quality and accountability in higher education. Student affairs, as well as their academic counterparts, must show that they function effectively and contribute to student learning and development. A promising program review process for student affairs to fulfill this expectation is found in the Education Criteria of the Malcolm Baldrige National Quality Award and its state-level equivalent, the Texas Award for Performance Excellence in Education Criteria. The purpose of this study was to determine the usefulness of the Texas Award for Performance Excellence Education Criteria, Progress Level, as the basis for a comprehensive program review in two diverse student affairs departments. Additionally, the study was to determine the potential usefulness of the Criteria as a management strategy for senior leadership in each department to focus on assessment, planning, improvement and change. The descriptive case study was conducted using naturalistic inquiry methodology with two student affairs departments. The researcher spent nine months in the field as a participant observer. Methodology included observations of training and team leader meetings; interviews with participants, department directors, and the Office of the Vice President; document review of both self-study reports; and the researcher’s reflexive journal. Student affairs departments are particularly well-suited for the quality concept of serving customers and, in this case, students as their primary customer. The researcher concluded that the Texas Award for Performance Excellence in Education Criteria serve as a useful basis for a comprehensive program review and as a management strategy for senior leadership under the following conditions: The department must be a mature and functional unit. Student affairs staff need a foundation in quality principles, in general, and the core values, Criteria and language of the Texas Award for Performance Excellence in Education before embarking on the self-study process. The Measurement, Analysis and Knowledge Category and the Planning Category provided the most introspection and action planning for both departments. The Process Category was the most challenging for both departments.

No description available.

Problem Performance management på individnivå innebär att styra individen utifrån individuella mål som förmedlar organisationens övergripande strategi till medarbetarna. För att förstärka styreffekterna av individuella mål kan en belöning kopplas till måluppfyllelsegrad. Effekten av ett bonussystem ställer stora krav på samarbete mellan chef och anställd då de tillsammans ska ställa upp realistiska mål som syftar till att utveckla den enskilde individen samtidigt som de bidrar till organisationens övergripande mål och resultat. Därmed är det viktigt att undersöka hur medarbetare och chefer påverkas av individuella mål kopplade till bonus och vilka effekter detta får inom företaget. Vilken effekt har målsättnings-, uppföljnings- och utvärderingsarbetet på styrning och motivation bland medarbetare och chefer? Syfte Syftet är att undersöka och öka förståelsen kring hur styrning och motivations-aspekter påverkas då performance management bryts ner till individnivå samt hur en belöningskoppling kan förstärka den eventuella styreffekten. Metod Undersökningen har genomförts i form av en fallstudie där intervjuer använts som främsta empiriinsamlingsmetod. Intervjuverktyget valdes för att få en förståelse för hur performance management påverkar personer inom en organisation utifrån ett styr- och motivations-perspektiv. Det gav möjlighet till att undersöka problemet på en djupare nivå där olika synsätt och åsikter kring ämnet kunde fångas upp under personliga intervjuer. Resultat Undersökningen visar att styrfilosofin inom en organisation inte påverkas i nämnvärd utsträckning av performance management på individnivå. Det som påverkas är hur organisationen väljer att hantera styrningen i form av de svårigheter som uppstår i och med att målen blir individuella. De största svårigheterna med ett individuellt målsättningsprogram är att få en jämvikt mellan finansiella och ickefinansiella mätetal där målen kommuniceras och förankras hos medarbetarna på ett fungerande sätt. Trots att de mjuka målen uppfattas som oerhört viktiga på individnivå så är det dessa mål som skapar de största svårigheterna. Fallstudien har visat att en tydlig målsättning med konkreta och realistiska mål är en förutsättning för att påverka styrningen i positiv riktning. Det framgår även att rättvisa är viktigt i och med att en bonus kopplas till måluppfyllelsegrad varför kvalitén på målsättningsarbete och uppföljningen är av stor vikt. / Problem Performance management helps the organisation clarify the strategy through individual targets. To reinforce the management effect a bonus can be connected to the fulfilment of targets. When a bonus is connected to performance management it is vital that the communication between managers and co-workers is well functioning and that the individual targets support the co-workers learning as well as they support the organizations overall targets. Therefore it is important to investigate how co-workers and managers are affected by individual targets and what consequences it has on the organization. What impact has the target setting-, follow up- and evaluation process on the organisation’s management and the motivation among the staff? Purpose The purpose of this study is to investigate and increase the understanding of how management and motivational aspects is affected when performance management is broken down to individual levels and how a reward can enhance the possible control effect. Method This study has been performed through a case study where interviews have been the primary method. Several interviews were conducted to gain an understanding of how performance management influences employees in an organization on the basis of a control and motivational aspect. Interviews made it possible to examine the purpose on a deeper level, where different opinions and approaches to performance management could be collected. Result The control function is not influenced by the fact that performance management is broken down to individual levels. The difficulty with this topic is the problems that arise when targets are made individualized. Individual targets make it hard to find a balance between financial and non-financial measurements and to gain the approval of employees. Non-financial goals cause the biggest problems since these are the hardest goals to measure and reward. Despite problems surrounding the non-financial goals there exist a great confidence in such goals. The case study shows that performance management on an individual level demands a well functioning communication to effect organisational management in a positive direction. It also shows that a bonus connected to targets demands a high quality in the rewarding procedure where justice plays an important part.