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

Abstract

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

Value-Based Provider Payment Initiatives Combining Global Payments With Explicit Quality Incentives: A Systematic Review

“…Our findings correspond well with the results of a recent review of outcome-based P4P initiatives, which found favorable effects only when P4P was combined with global base payments (Vlaanderen et al, 2019). Conversely, our findings are in contrast with results from prior reviews on the effects of P4P, which did not find convincing evidence for P4P being (cost-)effective in improving value when the underlying, flawed base payment system is left intact (e.g., Eijkenaar, Emmert, Scheppach, & Schöffski, 2013;Mendelson et al, 2017;Vlaanderen et al, 2019). A possible explanation for the latter is that P4P typically concerns a relatively small part of the total provider payment, whereas initiatives included in this article focus on reform of the total payment system.…”

“…Empirical work supports the theoretical rationale of a two-component VBP model. Vlaanderen et al (2019), for example, conclude that using explicit incentives for (outcome) quality paired with global base payments seems preferred over using explicit quality incentives alone.…”

Moving Parkinson care to the home

“…Kaiser Permanente, a large integrated health system in the U.S., uses internet, mobile, and, more recently, video technology to improve outcomes and increase convenience for its patients. 42,43 In the Netherlands, ParkinsonNet is developing an integrated reimbursement system to assist their network approach of care delivery, which includes many telehealth solutions as video consultations and online platforms for patients. Countries with single payer health systems, like Canada, Norway, or Luxemburg, are also poised to realize the advantages of home-based care for PD.…”

Impact of a Global Pandemic on Health Technology Assessment

“…It may be that faced with such a situation, HTA agencies and other healthcare funders will rely more heavily on other coverage decision approaches such as risk sharing arrangements or managed access schemes [45]. These innovative market access policies may be accompanied by innovations in pricing arrangements, including outcome-based payments [46], thereby promoting patient access despite the uncertainty in the evidence base and an aversion to risk at times of financial crisis [47].…”