The Massachusetts Group Insurance Commission (GIC) is the state's largest purchaser of health care after Medicaid, covering more than 267,000 state employees, retirees, and their dependents. In 2003, the GIC launched the Clinical Performance Improvement initiative, focused on improving provider performance and quality of care. CPI requires health plans under contract with the GIC to incorporate provider "tiering"--differential payments based on value--into their GIC product. After early data delays, group tiering began in the third year of the contract, and individual physician tiering began in the fourth year. The challenges involved in statewide tiering of providers are formidable, but stakeholders view the GIC as the only body in the state that could successfully push for such a quality improvement measure and succeed. The GIC's lead in value-driven purchasing has informed the state's recently enacted health care reform legislation.
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