It is estimated that 66% of total health care spending in the United States is directed toward care for about 27% of individuals with multiple chronic conditions.1 Many policy experts suggest that improving the quality of chronic disease management is a key strategy in controlling costs. Thus, insurers and payers are creating and evaluating incentives to improve the quality of care, including reducing the underuse, overuse, and misuse of clinical services.2 Pay for performance (P4P) is one of the most common strategies under evaluation, and the types of P4P incentives may vary based on whether it is implemented in a capitated or fee-for-service environment or on the size of the practice.3
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