Evaluating pay-for-performance in medicaid through real-world observation.

Health services researchers use a variety of methods to answer questions surrounding the use of incentives for quality. The current work by Suzanne Felt-Lisk and colleagues suffers from some limitations that may be inherent to many kinds of research, but it also overcomes a number of limitations and offers important insights into why some pay-for-performance (P4P) efforts are more successful than others. The work contributes to Medicaid payment policy and to the P4P literature more generally. In the future, it will be important for researchers to build on "exploratory" observational studies like those of Felt-Lisk and colleagues' study and others by testing explicit "behavioral models" of individual physician or physician practice responses to P4P.