Impact of pay for performance on behavior of primary care physicians and patient outcomes

Lin, Yifei; Yin, Senlin; Huang, Jin; Li, Du

doi:10.1111/jebm.12185

Cited by 9 publications

(12 citation statements)

References 53 publications

(257 reference statements)

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“…The finding that ACOs do not reduce and may even improve some measures of patient satisfaction and perceived quality of care suggests that ACOs have not prompted the patient frustration associated with the HMO model, potentially due to the preservation of patient choice in providers in the ACO model among other differences (Miller & Luft, 2002). Similar to ACOs, P4P programs have been associated with small positive effects on the process measures targeted; however, neither model has demonstrated consistent effects on health outcomes (Flodgren et al, 2011; Gilmore et al, 2007; Lin, Yin, Huang, & Du, 2016; Mendelson et al, 2017; Rosenthal & Frank, 2006; Rosenthal, Frank, Li, & Epstein, 2005; Rosenthal, Landon, Normand, Frank, & Epstein, 2006; Rosenthal, Landrum, Robbins, & Schneider, 2016; Sutton et al, 2012; Werner, Konetzka, & Polsky, 2013). To improve population health and outcomes, ACO programs may need to incentivize measures of quality that are more closely tied to outcomes.…”

Section: Discussionmentioning

confidence: 99%

Impact of Accountable Care Organizations on Utilization, Care, and Outcomes: A Systematic Review

et al. 2017

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Since 2010, more than 900 accountable care organizations (ACOs) have formed payment contracts with public and private insurers in the United States; however, there has not been a systematic evaluation of the evidence studying impacts of ACOs on care and outcomes across payer types. This review evaluates the quality of evidence regarding the association of public and private ACOs with health service use, processes, and outcomes of care. The 42 articles identified studied ACO contracts with Medicare ( N = 24 articles), Medicaid ( N = 5), commercial ( N = 11), and all payers ( N = 2). The most consistent associations between ACO implementation and outcomes across payer types were reduced inpatient use, reduced emergency department visits, and improved measures of preventive care and chronic disease management. The seven studies evaluating patient experience or clinical outcomes of care showed no evidence that ACOs worsen outcomes of care; however, the impact on patient care and outcomes should continue to be monitored.

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Section: Discussionmentioning

confidence: 99%

Impact of Accountable Care Organizations on Utilization, Care, and Outcomes: A Systematic Review

et al. 2017

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“…Payment models are designed to produce financial incentives in order to achieve certain goals. Examples are capitation, episode-based and bundled payment, shared savings, pay for performance (PFP), and retainer-based practice 38 . They are designed from different points of view e.g.…”

Section: Resultsmentioning

confidence: 99%

Understanding the nature of health: New perspectives for medicine and public health. Improved wellbeing at lower costs

Bircher

Hahn

2016

F1000Res

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Background: Current dilemmas of health care systems call for a new look at the nature of health. This is offered by the Meikirch model. We explore its hypothetical benefit for the future of medicine and public health. Meikirch model: It states: “Health is a dynamic state of wellbeing emergent from conducive interactions between individuals’ potentials, life’s demands, and social and environmental determinants.” “Throughout the life course health results when an individuals’ biologically given potential (BGP) and his or her personally acquired potential (PAP), interacting with social and environmental determinants, satisfactorily respond to the demands of life.” Methods: We explored the Meikirch model’s possible applications for personal and public health care. Results: The PAP of each individual is the most modifiable component of the model. It responds to constructive social interactions and to personal growth. If an individual’s PAP is nurtured to develop further, it likely will contribute much more to health than without fostering. It may also compensate for losses of the BGP. An ensuing new culture of health may markedly improve health in the society. The rising costs of health care presumably are due in part to the tragedy of the commons and to moral hazard. Health as a complex adaptive system offers new possibilities for patient care, particularly for general practitioners. Discussion: Analysis of health systems by the Meikirch model reveals that in many areas more can be done to improve people’s health and to reduce health care costs than is done today. The Meikirch model appears promising for individual and public health in low and high income countries. Emphasizing health instead of disease the Meikirch model reinforces article 12 of the International Covenant on Economic, Social and Cultural Rights of the United Nations – that abandons the WHO definition - and thereby may contribute to its reinterpretation.

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“…There are also ethical issues and concerns regarding its impact on deprived population groups leading to worsening health inequalities. P4P programmes oftentimes focus only on process and structural indicators without measuring the effect on outcomes, such as mortality [ 8 ].…”

Section: Introductionmentioning

confidence: 99%

Delivering maternal and childcare at primary healthcare level: The role of PMAQ as a pay for performance strategy in Brazil

et al. 2020

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Background Improving access and quality in health care is a pressing issue worldwide and pay for performance (P4P) strategies have emerged as an alternative to enhance structure, process and outcomes in health. In 2011, Brazil adopted its first P4P scheme at national level, the National Programme for Improving Primary Care Access and Quality (PMAQ). The contribution of PMAQ in achieving the Sustainable Development Goals related to maternal and childcare remains under investigated in Brazil. Objective To estimate the association of PMAQ with the provision of maternal and childcare in Brazil, controlling for socioeconomic, geographic and family health team characteristics. Method We used cross-sectional quantile regression (QR) models for two periods, corresponding to 33,368 Family Health Teams (FHTs) in the first cycle and 39,211 FHTs in the second cycle of PMAQ. FHTs were analysed using data from the Brazilian Ministry of Health (SIAB and CNES) and the Brazilian Institute for Geography and Statistics (IBGE). Results The average number of antenatal consultations per month were positively associated with PMAQ participating teams, with larger effect in the lower tail (10 th and 25 th quantiles) of the conditional distribution of the response variable. There was a positive association between PMAQ and the average number of consultations under 2 years old per month in the 10 th and 25 th quantiles, but a negative association in the upper tail (75 th and 90 th quantiles). For the average number of physician consultations for children under 1 year old per month, PMAQ participating teams were positively associated with the response variable in the lower tail, but different from the previous models, there is no clear evidence that the second cycle gives larger coefficients compared with first cycle. Conclusion PMAQ has contributed to increase the provision of care to pregnant women and children under 2 years at primary healthcare level. Teams with lower average number of antenatal or child consultations benefited the most by participating in PMAQ, which suggests that PMAQ might motivate worse performing health providers to catch up.

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Impact of pay for performance on behavior of primary care physicians and patient outcomes

Cited by 9 publications

References 53 publications

Impact of Accountable Care Organizations on Utilization, Care, and Outcomes: A Systematic Review

Impact of Accountable Care Organizations on Utilization, Care, and Outcomes: A Systematic Review

Understanding the nature of health: New perspectives for medicine and public health. Improved wellbeing at lower costs

Delivering maternal and childcare at primary healthcare level: The role of PMAQ as a pay for performance strategy in Brazil

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