Effects of Health Care Payment Models on Physician Practice in the United States

Friedberg, Mark W.; Chen, Peggy G.; White, Chapin; Jung, Olivia; Raaen, Laura; Hirshman, Samuel; Hoch, Emily; Stevens, Clare; Ginsburg, Paul Β.; Casalino, Lawrence P.; Tutty, Michael; Vargo, Carol; Lipinski, Lisa

doi:10.7249/rr869

Cited by 49 publications

(53 citation statements)

References 101 publications

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“…Policymakers and ACO contract designers could help to promote greater use of nonfinancial motivators through timely transparency of performance data and communication of the quantifiable and qualitative impacts on patients as a result of an ACO. Additionally, and as others have highlighted before, policymakers should encourage harmonization of quality metrics across plans and programs to remove barriers to the effective use of a range of motivators.…”

Section: Discussionmentioning

confidence: 97%

More Than Money: Motivating Physician Behavior Change in Accountable Care Organizations

Phipps-Taylor

Shortell

2016

Milbank Quarterly

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Policy Points:r For accountable care organizations (ACOs) to be successful they need to change the behavior of their physicians. To stimulate this change, a broad range of motivators are being used, including ways to see a greater impact on patients (social purpose) and opportunities to be a more effective physician (mastery), in addition to personal financial incentives.r From our analysis of case studies, it does not appear that the full range of motivators is being deployed by ACOs, which suggests an opportunity to develop more sophisticated and wider-ranging portfolios of motivators for greater impact. Context:There are approximately 800 accountable care organizations (ACOs) in the United States. In order to achieve the ACO goals of reduced cost, improved outcomes of care, and better population health, it is critical to change how physicians within ACOs deliver care. While knowledge of ACO development and evolution is growing, relatively little is known about the motivational drivers that are being used to effect change among participating physicians. Methods:We synthesized 9 well-established and empirically tested theories of motivation into an overarching framework of 6 motivator domains. This framework was then used to explore the types of motivators that leaders use to stimulate change within 4 case study ACOs. We explored the organizational characteristics, strategies, and motivators for changing physicians' behaviors through in-depth interviews and document review. Findings:The case study ACOs more strongly emphasized nonfinancial motivators for changing physician behavior than financial incentives. These

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Section: Discussionmentioning

confidence: 97%

More Than Money: Motivating Physician Behavior Change in Accountable Care Organizations

Phipps-Taylor

Shortell

2016

Milbank Quarterly

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“…41 Practices can also achieve direct revenue through quality bonus incentive payments with commercial and government payers through the Merit-Based Incentive Payment System (MIPS) and pay-for-performance (P4P) models. 42,43 Due to the recent Medicare physician reimbursement overhaul known as the Medicare Access and CHIP Reauthorization Act of 2015, primary care physicians will be engaged in upside-downside risk adjustments that can affect up to 9% of their Medicare reimbursement. 43 These adjustments will be based on MIPS composite scores that incentivize quality, efficient resource utilization, practice quality improvement activities, and advancement of health information technology.…”

Section: Cmm From a Primary Care Practice Perspectivementioning

confidence: 99%

Making the economic value proposition for pharmacist comprehensive medication management (CMM) in primary care: A conceptual framework

Tripicchio

Urick

Easter

et al. 2020

Research in Social and Administrative Pharmacy

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Introduction: Comprehensive medication management (CMM) is a patient care process provided by clinical pharmacists in primary care settings that ensures optimal use of medications with timely followup. Despite widespread evidence that shows CMM improves clinical and medication-related outcomes, pharmacist CMM services often fail to be adopted into U.S. primary care settings. Objective: This study presents a conceptual framework linking outcomes of pharmacist-delivered CMM services in primary care settings to financial benefits for both primary care practices investing and implementing CMM and health plans providing coverage of CMM services. Methods: A narrative literature review was performed in PubMed and the gray literature to identify financing opportunities that justify the coverage of CMM by third party health plan administrators or the implementation of CMM by primary care practices. Financing elements that could be impacted by pharmacist-led CMM outcomes, namely higher achievement of medication-related quality measures and reduction of total costs of care, were recorded and utilized to develop the conceptual framework. Results: The framework suggests that CMM may provide economic benefits to health plans and care practices by (1) increasing market competitiveness through higher quality ratings, accreditation recognition, lower premiums and plan bids, and increased patient satisfaction; and (2) increasing revenue through quality bonus payments, shared savings agreements, and fee-for-service reimbursement. Conclusions: The alignment of economic benefits that can be realized through CMM advances a strong value proposition for greater adoption of CMM in the United States' primary care system. Future application of this study's conceptual framework could include use as an advocacy tool amongst pharmacy associations or as a tool for individuals seeking buy-in for CMM services.

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“…As noted, one factor underlying the more recent hospital‐physician integration trend is the growing use of pay‐for‐performance approaches. In an effort to improve the performance of health care providers, including hospitals, health plans and government insurance programs are adopting performance metrics to which reimbursement for patient care is linked (Conrad & Perry, ; Young, ; Friedberg et al., ). Higher scores on these metrics result in greater reimbursement.…”

Section: Literature Review and Hypothesesmentioning

confidence: 99%

The Effect of Hospital‐Physician Integration on Operational Performance: Evaluating Physician Employment for Cardiovascular Services

2019

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A dramatic change in the hospital industry is the increasing emphasis on linking provider payment to quality performance metrics. This is one of several considerations leading hospitals to employ physicians. Yet, there is little evidence regarding whether physician employment as a form of hospital‐physician integration leads to better operational performance. Using data from 201 California hospitals that experienced a total of 405,766 eligible opportunities to conform to external performance metrics (conformance quality) for treating patients in the cardiovascular service area, we empirically evaluated the relationship between physician employment and conformance quality. We also evaluated whether the presence of core capabilities in the hospital's cardiovascular service area complements or substitutes for physician employment. Findings suggest that physician employment is not only positively associated with conformance quality, but also associated with more consistent conformance quality. Moreover, the presence of core capabilities in the service area substitutes for physician employment. Theoretical, managerial, and policy implications are discussed.

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Effects of Health Care Payment Models on Physician Practice in the United States

Cited by 49 publications

References 101 publications

More Than Money: Motivating Physician Behavior Change in Accountable Care Organizations

More Than Money: Motivating Physician Behavior Change in Accountable Care Organizations

Making the economic value proposition for pharmacist comprehensive medication management (CMM) in primary care: A conceptual framework

The Effect of Hospital‐Physician Integration on Operational Performance: Evaluating Physician Employment for Cardiovascular Services

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