Letter: Wisconsin Medicaid uses method to stop the gaming of performance measures

Regarding the Government Health IT article, "Gaming the system,": Gaming results on performance measures used as the basis for pay-for-performance incentive payments is a particularly critical problem. As this article points out, it can occur at the provider level, when it is the practitioner who stands to gain, but it can also occur at the system level. For example, when the incentive is to be paid to an HMO, PPO, or other large delivery system. This would be the case in state Medicaid programs attempting to use [pay for performance] in HMO-based managed care delivery systems.

In that case, which is becoming much more common these days, HMO-reported performance data is particularly vulnerable to gaming and it could prove to be even more difficult and costly to detect.  So called "compliance audits" used in some old measure systems do not detect or prevent gaming; merely that the technical specifications were followed.

The solution is already in operation in Wisconsin's Medicaid managed care program: automated performance measures the results of which are calculated by an independent third party under contract with the state. The HMOs have no opportunity to game the results, because not only do they not calculate and report their own results, they don't control all the electronic data streams used for calculating all the measures. The measures are called MEDDIC-MS, which stands for Medicaid Encounter Data Driven Improvement Core Measure Set


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