Could Pay-for-Performance Worsen Health Disparities?

Shakir, Mubeen; Armstrong, Katrina; Wasfy, Jason H.

doi:10.1007/s11606-017-4243-3

Cited by 23 publications

(26 citation statements)

References 13 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Financial incentives run the risk of exacerbating these disparities across providers. For example: there is evidence that safety net hospitals suffer more from the financial penalties introduced by P4P than other hospitals [ 106 ].…”

Section: Discussionmentioning

confidence: 99%

Design and effects of outcome-based payment models in healthcare: a systematic review

et al. 2018

View full text Add to dashboard Cite

Introduction Outcome-based payment models (OBPMs) might solve the shortcomings of fee-for-service or diagnostic-related group (DRG) models using financial incentives based on outcome indicators of the provided care. This review provides an analysis of the characteristics and effectiveness of OBPMs, to determine which models lead to favourable effects. Methods We first developed a definition for OBPMs. Next, we searched four data sources to identify the models: (1) scientific literature databases; (2) websites of relevant governmental and scientific agencies; (3) the reference lists of included articles; (4) experts in the field. We only selected studies that examined the impact of the payment model on quality and/or costs. A narrative evidence synthesis was used to link specific design features to effects on quality of care or healthcare costs. Results We included 88 articles, describing 12 OBPMs. We identified two groups of models based on differences in design features: narrow OBPMs (financial incentives based on quality indicators) and broad OBPMs (combination of global budgets, risk sharing, and financial incentives based on quality indicators). Most (5 out of 9) of the narrow OBPMs showed positive effects on quality; the others had mixed (2) or negative (2) effects. The effects of narrow OBPMs on healthcare utilization or costs, however, were unfavourable (3) or unknown (6). All broad OBPMs (3) showed positive effects on quality of care, while reducing healthcare cost growth. Discussion Although strong empirical evidence on the effects of OBPMs on healthcare quality, utilization, and costs is limited, our findings suggest that broad OBPMs may be preferred over narrow OBPMs.Keywords Outcome-based payment models · Health reform · Payment models in healthcare · Health outcomes · Healthcare costs · Quality of care JEL I180

show abstract

Section: Discussionmentioning

confidence: 99%

Design and effects of outcome-based payment models in healthcare: a systematic review

et al. 2018

View full text Add to dashboard Cite

show abstract

“…Likewise, SNCs serving patients with high burdens of SDOH are more likely to be financially punished by quality-based payment systems [ 33 ], which would leave them with even fewer resources to focus on both quality metrics and their patients’ social complexities. Furthermore, the inequitable selection biases that have designed and chosen these measures have resulted in metrics that may not be as important to vulnerable populations served by SNCs, [ 11 , 12 ]; other health issues as defined by communities themselves may be more valuable, such as mental health and substance use [ 1 ].…”

Section: Discussionmentioning

confidence: 99%

“…Quality metrics, pay for performance (P4P), and value-based payments (VBP) are prominent aspects of the current and future American healthcare system, which may impact health disparities [ 1 ]. It is recognized that variability in clinics’ quality scores used to compare quality between clinics and between providers can be attributed in part to patient population factors beyond the scope or control of traditional care delivery and patient behaviors, such as poverty, housing, education, and employment [ 2 , 3 ].…”

Section: Introductionmentioning

confidence: 99%

“…It is recognized that variability in clinics’ quality scores used to compare quality between clinics and between providers can be attributed in part to patient population factors beyond the scope or control of traditional care delivery and patient behaviors, such as poverty, housing, education, and employment [ 2 , 3 ]. Health care systems and providers serving patients with lower socioeconomic status (SES) or higher burdens of poor structural determinants of health (SDOH) may be disproportionately impacted by P4P, thus widening already evident quality disparities [ 1 , 4 ].…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Primary care clinicians’ perspectives about quality measurements in safety-net clinics and non-safety-net clinics

Culhane‐Pera¹,

Ortega²,

Thao

et al. 2018

Int J Equity Health

View full text Add to dashboard Cite

BackgroundQuality metrics, pay for performance (P4P), and value-based payments are prominent aspects of the current and future American healthcare system. However, linking clinic payment to clinic quality measures may financially disadvantage safety-net clinics and their patient population because safety-net clinics often have worse quality metric scores than non-safety net clinics. The Minnesota Safety Net Coalition’s Quality Measurement Enhancement Project sought to collect data from primary care providers’ (PCPs) experiences, which could assist Minnesota policymakers and state agencies as they create a new P4P system. Our research study aims are to identify PCPs’ perspectives about 1) quality metrics at safety net clinics and non-safety net clinics, 2) how clinic quality measures affect patients and patient care, and 3) how payment for quality measures may influence healthcare.MethodsQualitative interviews with 14 PCPs (4 individual interviews and 3 focus groups) who had worked at both safety net and non-safety net primary care clinics in Minneapolis-St Paul Minnesota USA metropolitan area. Qualitative analyses identified major themes.ResultsThree themes with sub-themes emerged. Theme #1: Minnesota’s current clinic quality scores are influenced more by patients and clinic systems than by clinicians. Theme #2: Collecting data for a set of specific quality measures is not the same as measuring quality healthcare. Subtheme #2.1: Current quality measures are not aligned with how patients and clinicians define quality healthcare. Theme #3: Current quality measures are a product of and embedded in social and structural inequities in the American health care system. Subtheme #3.1: The current inequitable healthcare system should not be reinforced with financial payments. Subtheme #3.2: Health equity requires new metrics and a new healthcare system. Overall, PCPs felt that the current inequitable quality metrics should be replaced by different metrics along with major changes to the healthcare system that could produce greater health equity.ConclusionAligning payment with the current quality metrics could perpetuate and exacerbate social inequities and health disparities. Policymakers should consider PCPs’ perspectives and create a quality-payment framework that does not disadvantage patients who are affected by social and structural inequities as well as the clinics and providers who serve them.Electronic supplementary materialThe online version of this article (10.1186/s12939-018-0872-3) contains supplementary material, which is available to authorized users.

show abstract

“…4 We must avoid the vicious cycle of poverty-driven health outcome failures begetting fewer healthcare resources rather than the large investment actually needed to address existing inequities and the many barriers to better health. 5…”

mentioning

confidence: 99%

Capsule Commentary on Okunrintemi et al., Association of Income Disparities with Patient Reported Healthcare Experience

Schectman

2019

J GEN INTERN MED

View full text Add to dashboard Cite

ture Panel Survey (MEPS) data on income-related disparities in experiences with the healthcare system is an important contribution to the literature. The finding of worse access to care, delays in care, and dissatisfaction with the care received by low-income individuals is certainly not surprising but should nonetheless be alarming given the current retreat on recent healthcare reforms designed to enhance equity in the delivery and receipt of care in the USA. The authors' findings were fairly similar across racial and ethnic groups when adjusted for income (figure e1) but the income disparities in healthcare experience were accentuated by lack of health insurance (figure e2). This analysis of recent nationally representative survey data confirms that there is substantial income-based disparity in patient healthcare experiences just as there are substantial disparities in healthcare outcomes in the USA. 2, 3 Since healthcare in the USA is a moving, evolving target, this report is limited by the survey data being 6-8 years old-pre-dating implementation of the Affordable Care Act. It will be interesting to see whether more recent MEPS Survey panels demonstrate different healthcare experiences by income and insurance subgroup. Though the reported analyses are restricted to patients having a Bregular healthcare provider^(which might tend to level the playing field across incomes), results were similar without this restriction (Table e3).

show abstract

Could Pay-for-Performance Worsen Health Disparities?

Cited by 23 publications

References 13 publications

Design and effects of outcome-based payment models in healthcare: a systematic review

Design and effects of outcome-based payment models in healthcare: a systematic review

Primary care clinicians’ perspectives about quality measurements in safety-net clinics and non-safety-net clinics

Capsule Commentary on Okunrintemi et al., Association of Income Disparities with Patient Reported Healthcare Experience

Contact Info

Product

Resources

About