Pay-for-performance step-by-step: Introduction to the MIMIQ model

Objectives: Pay-for-performance is increasingly used as a system intervention to support quality improvement. Programs are however developed, implemented and evaluated in a heterogeneous way. This is partly due to the broad and disparate theoretical and empirical foundation of P4P practice, which is rapidly evolving. This paper guides the reader through the essential steps which should be taken into consideration when setting up a P4P program. To this end a model called 'Model for Implementing and Monitoring Incentives for Quality' (MIMIQ) is presented. Methods: Literature review was performed with a search of multiple databases, reference screening and expert consultation. Results: Central to the step-by-step approach is a Plan-Do-Check-Act cycle which incorporates communication, implementation and evaluation as key phases next to program development. In addition, the model explains how the decision making and results of each phase is modified by contextual factors. The model puts emphasis on quality and quality measurement as first items to develop. Only after these are in place, the development of the incentive component can be addressed. Conclusions: The model presents guidance for designing and implementing P4P programs in a practically structured way. According to future findings the MIMIQ model will continuously evolve as an up to date P4P policy and practice tool. (C) 2010 Elsevier Ireland Ltd. All rights reserved.