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This dissertation aims to explore the performance of health provider participation inthe Medicare Quality Payment Program by investigating the relationship among the performance metrics of value and quality and the capacities of geography, technology, finance, and administration. There is a theory-practice gap in the research that examines the impact of these capacities on the value and quality of clinical services delivered by healthcare providers participating in the Medicare Quality Payment Program. The study will address this theory-practice gap by applying the capacity-performance paradigm to better understand the influences of geographical, technological, financial, and administrative capacity have on the performance of value and quality metrics of healthcare providers engaging in the Medicare Quality Payment Program. This study also provides prudent findings that demonstrate the impact of the capacities on the performance of value and quality among healthcare providers which can influence programmatic policy reforms by policymakers who are overseeing the Quality Payment Program. This study utilizes the CMS 2021 QPP Experience dataset which contains the performance outcome metrics of value and quality among healthcare providers participating in the program. Ordinary Least Squares (OLS) regression is employed to examine the relationship among the capacities of geography, technology, finance, and administration and the performance providers. The findings of this study show a significant relationship between these capacities and the performance outcome metrics of value and quality among healthcare providers participating in the Medicare Quality Payment Program.

In 2013, Medicare launched the Bundled Payments for Care Improvement (BPCI) Initiative which linked payments for multiple services for a complete episode of patient care. With this innovative reimbursement model, hospitals accepted fixed target payments for certain types of clinical diagnoses that were intended to support better care coordination and better outcomes for patients at lower cost to Medicare. This was one of many programs aimed at addressing the serious challenges facing United States healthcare, including costs that are skyrocketing to unsustainable levels and lack of coordination of care across venues. Preliminary Medicare results showed that bundled payments might lead to lower costs and higher quality of care, however, this idea comes from a relatively small sample size and limited run time of the program. This study examined one large community hospital in the southeast part of the United States participating in the BPCI Initiative. Patient level data was retrospectively analyzed using statistical techniques to determine if financial, operational and clinical outcomes improved as result of the BPCI program compared to similar patient data before the program. The results were mixed. Financial outcomes did not change significantly, and remained higher than the CMS targets. Length of stay decreased significantly, as anticipated. The 30-day readmissions was statistically unchanged. This study illuminated both challenges and strategies in implementing bundled payments to achieve positive financial, operational, and clinical outcomes.