Incentive-Based Primary Care: Cost and Utilization Analysis

Hollander, Marcus J.; Kadlec, Helena

doi:10.7812/tpp/15-045

Cited by 16 publications

(5 citation statements)

References 28 publications

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“…There were improvements in satisfaction for providers whose payment model factored in panel size. The three studies that impacted comprehensiveness and coordination 44 – 46 reported: improvements in older populations for depression and dyspnoea, but no changes for other behavioural disorders, pain and falls; improvements for unplanned hospitalisations and increased preventive measures, and cost avoidance and decreased service utilisation for chronic conditions in incentive-based services. There were no changes in total hospital admissions, and increased costs for incentive-based diabetes services.…”

Section: Resultsmentioning

confidence: 99%

Multicomponent interventions for enhancing primary care: a systematic review

et al. 2020

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BackgroundMany countries have implemented interventions to enhance primary care to strengthen their health systems. These programmes vary widely in features included and their impact on outcomes.AimTo identify multiple-feature interventions aimed at enhancing primary care and their effects on measures of system success — that is, population health, healthcare costs and utilisation, patient satisfaction, and provider satisfaction (quadruple-aim outcomes).Design and settingSystematic review and narrative synthesis.MethodElectronic, manual, and grey-literature searches were performed for articles describing multicomponent primary care interventions, providing details of their innovation features, relationship to the ‘4Cs’ (first contact, comprehensiveness, coordination, and continuity), and impact on quadruple-aim outcomes. After abstract and full-text screening, articles were selected and their quality appraised. Results were synthesised in a narrative form.ResultsFrom 37 included articles, most interventions aimed to improve access, enhance incentives for providers, provide team-based care, and introduce technologies. The most consistent improvements related to increased primary care visits and screening/preventive services, and improved patient and provider satisfaction; mixed results were found for hospital admissions, emergency department visits, and expenditures. The available data were not sufficient to link interventions, achievement of the 4Cs, and outcomes.ConclusionMost analysed interventions improved some aspects of primary care while, simultaneously, producing non-statistically significant impacts, depending on the features of the interventions, the measured outcome(s), and the populations being studied. A critical research gap was revealed, namely, in terms of which intervention features to enhance primary care (alone or in combination) produce the most consistent benefits.

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Section: Resultsmentioning

confidence: 99%

Multicomponent interventions for enhancing primary care: a systematic review

et al. 2020

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“…There is also great diversity with regard to the country where the intervention is reported. Some studies focus on the role of financial incentives in the United States ( n = 5), Taiwan ( n = 4), United Kingdom ( n = 3), Sweden [ 26 ], Japan [ 41 ], Germany [ 29 ], Canada [ 36 ], Norway [ 40 ] and Ireland [ 42 ]. Two studies do not focus on any particular intervention country but rather discuss the importance of appropriate financial incentives [ 30 , 34 ].…”

Section: Resultsmentioning

confidence: 99%

“…For instance, providers may get rewarded for improving structure, outcome and process indicators [ 29 , 33 , 44 ] or for inter-provider care planning [ 41 ]. Most studies, 8 out of 9, discuss the role of P4P programs in rewarding healthcare providers [ 26 , 31 – 33 , 35 , 36 , 38 , 44 ]. The study by Yu, Tsai & Kung (2013) [ 44 ] presents the P4P program for diabetes care implemented in Taiwan that provided financial incentives to medical care personnel for enhanced monitoring and subsequent care for patients along with a bonus for improved treatment outcomes.…”

Section: Resultsmentioning

confidence: 99%

“…Studies on financial rewards provide mixed results. For instance, Hollander & Kadiec (2015) [ 36 ] show that the use of rewards related to care transition can and do avoid costs for the health care system and reduce hospital utilization. Study reported on four conditions that are common among geriatric patients: diabetes, coronary heart failure, congestive pulmonary disease, and hypertension.…”

Section: Resultsmentioning

confidence: 99%

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Do financial aspects affect care transitions in long-term care systems? A systematic review

et al. 2022

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Background Suboptimal care transitions of older adults may ultimately lead to worse quality of care and increased costs for the health and social care systems. Currently, policies and financing often focus on care in specific settings only, and neglect quality of care during transitions between these settings. Therefore, appropriate financing mechanisms and improved care coordination are necessary for effective care transitions. This study aims to review all available evidence on financial aspects that may have an impact on care transitions in LTC among older adults. Methods This systematic review was performed as part of the European TRANS-SENIOR project. The databases Medline, EMBASE (Excerpta Medica Database) and CINAHL (Cumulated Index to Nursing and Allied Health Literature) were searched. Studies were included if they reported on organizational and financial aspects that affect care transitions in long-term care systems. Results All publications included in this review (19 studies) focused specifically on financial incentives. We identified three types of financial incentives that may play a significant role in care transition, namely: reimbursement mechanism, reward, and penalty. The majority of the studies discussed the role of rewards, specifically pay for performance programs and their impact on care coordination. Furthermore, we found that the highest interest in financial incentives was in primary care settings. Conclusions Overall, our results suggest that financial incentives are potentially powerful tools to improve care transition among older adults in long-term care systems and should be taken into consideration by policy-makers. Trial registration A review protocol was developed and registered in the International Prospective Register of Systematic Reviews (PROSPERO) under identification number CRD42020162566.

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“…This trend continued even once clinicians had reached their predefined maximum of three enrollment incentives, suggesting that an initial incentive, though finite, could be successful in establishing a sustainable behavior pattern. Prior work on the effects of financial incentives on physician performance is mixed [36]; however, our experience is that a small enrollment incentive can reliably and accurately facilitate initial CDSS uptake [23,37]. Bolstered with a 100% audit process, we were able to police the incentive system to prevent clinicians from "gaming it" (e.g., enrolling ineligible patients in order to receive an incentive).…”

Section: Discussionmentioning

confidence: 99%

Optimizing Clinical Decision Support in the Electronic Health Record

Vemula¹,

Chettipally²,

Kene³

et al. 2016

Appl Clin Inform

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SummaryObjective: Adoption of clinical decision support (CDS) tools by clinicians is often limited by workflow barriers. We sought to assess characteristics associated with clinician use of an electronic health record-embedded clinical decision support system (CDSS). Methods: In a prospective study on emergency department (ED) activation of a CDSS tool across 14 hospitals between 9/1/14 to 4/30/15, the CDSS was deployed at 10 active sites with an on-site champion, education sessions, iterative feedback, and up to 3 gift cards/clinician as an incentive. The tool was also deployed at 4 passive sites that received only an introductory educational session. Activation of the CDSS -which calculated the Pulmonary Embolism Severity Index (PESI) score and provided guidance -and associated clinical data were collected prospectively. We used multivariable logistic regression with random effects at provider/facility levels to assess the association between activation of the CDSS tool and characteristics at: 1) patient level (PESI score), 2) provider level (demographics and clinical load at time of activation opportunity), and 3) facility level (active vs. passive site, facility ED volume, and ED acuity at time of activation opportunity). Results: Out of 662 eligible patient encounters, the CDSS was activated in 55%: active sites: 68% (346/512); passive sites 13% (20/150). In bivariate analysis, active sites had an increase in activation rates based on the number of prior gift cards the physician had received (96% if 3 prior cards versus 60% if 0, p<0.0001). At passive sites, physicians < age 40 had higher rates of activation (p=0.03). In multivariable analysis, active site status, low ED volume at the time of diagnosis and PESI scores I or II (compared to III or higher) were associated with higher likelihood of CDSS activation. Conclusions: Performing on-site tool promotion significantly increased odds of CDSS activation. Optimizing CDSS adoption requires active education. Research Article Background and SignificanceThe goal of knowledge translation (KT) is to close the gap between proven science and real-time care delivery. Historically, the adoption of new evidence into clinical practice has lagged a decade or more -with variable uptake across physicians and settings [1,2]. While KT, and implementation science more generally, are relatively new fields of emphasis and study, previous work has identified barriers to effective KT as well as best practices for implementation [3].For example, Davidoff has stressed the importance of concentrating not only on the diffusion of new validated techniques and treatments into practice but also on the "undiffusion" of previous practice -especially amongst those physicians who may be prone to suffering from inertia when it comes to changing their practice [4]. Michie has described a behavior change wheel framework for identifying well-suited interventions (e.g., education, environmental context, etc.) to combat barriers to implementation of knowledge translation tools [5]. Diner has de...

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Incentive-Based Primary Care: Cost and Utilization Analysis

Cited by 16 publications

References 28 publications

Multicomponent interventions for enhancing primary care: a systematic review

Multicomponent interventions for enhancing primary care: a systematic review

Do financial aspects affect care transitions in long-term care systems? A systematic review

Optimizing Clinical Decision Support in the Electronic Health Record

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