My lede:

Scores of competing pay-for-performance programs using uncoordinated sets of quality measures have made it hard for physicians to earn health plan incentive payments and yielded little in the way of better patient care.

That is why hopes were high for the Integrated Healthcare Assn., a California quality collaborative whose P4P program drew the cooperation of the state’s seven largest HMOs and 225 medical groups representing 35,000 physicians. The health plans aggregated their data to capture physician performance more accurately, and everyone agreed on a common set of quality metrics.

From 2004 to 2007, IHA — operating the country’s biggest P4P program — paid out $203 million in bonus payments. But the quality breakthrough many expected has yet to arrive, according to a study in the March/April issue of Health Affairs, a leading policy journal (content.healthaffairs.org/cgi/content/abstract/28/2/517/).

The whole shebang.