This book examines the impact that changes to California's workers' compensation (WC) system have had on the medical care provided to injured workers, synthesizes findings from interviews and available information regarding the implementation of the changes affecting WC medical care, and identifies areas in which additional changes might increase the quality and efficiency of care delivered under the WC system.

These proceedings are the product of a May 2003 colloquium on the workers' compensation medical benefit delivery system, with a focus on the access, cost, and quality issues facing the system and mechanisms to improve its quality and efficiency.

Over the past few years, nonoccupational health-insurance programs and group health plans have implemented initiatives to improve the quality and efficiency of care through incentive programs, typically called "pay for performance," or P4P. In addition, Medicare program administrators are evaluating how P4P incentives might be incorporated into Medicare payment systems. A workers' compensation (WC) P4P program could be an effective strategy to improve the quality and efficiency of care, increase patient satisfaction, and improve work-related outcomes provided it is integrated with other initiatives to improve the WC medical treatment system. The program could reward only high-performing physicians or reward improvement from any physician, and payer and provider participation could be voluntary or mandatory. Challenges to implementation include lack of clinical measures for WC conditions, multiple payers, and multiple physicians treating few WC patients and the high level of contention among stakeholders. This paper assesses the options, challenges, and potential benefits of adopting P4P incentives for physician services in California2s WC program, offering three models of programs for consideration.