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

Abstract

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

Physician practices in Accountable Care Organizations are more likely to collect and use physician performance information, yet base only a small proportion of compensation on performance data

“…The fact that even in 2018, ACO practices do not appear to be using financial incentives as an important mechanism for influencing care delivery is an area for further study. It may be that the feedback of performance data and peer comparisons are more effective motivators than increasing the percent of individual compensation based on cost or quality metrics . One of the key challenges for implementing financial incentives is that some clinicians may have a small proportion of patients participating in ACOs, and thus, creating financial incentives that are large enough to change behavior may be challenging.…”

Moving Organizational Culture from Volume to Value: A Qualitative Analysis of Private Sector Accountable Care Organization Development

“…Interestingly, though not asked specifically about this shift, it was repeatedly discussed by interviewees who held a variety of jobs and also across diverse ACO sites. Another recent publication analyzing physician behavior change within ACOs presents four motivational domains for change beyond financial incentives—mastery, social purpose, autonomy, and relatedness (Phipps‐Taylor and Shortell ). Our findings suggest that the work of engaging physicians in the ACO and panel management are mechanisms that can facilitate physician behavior change by increasing motivation through identification with the ACO culture of value over volume.…”

“…). One recent exception is a study by Phipps‐Taylor and Shortell () that highlights nonfinancial elements of physician culture as central to strategic change toward ACO development.…”

Financial Incentives and Physician Practice Participation in Medicare's Value‐Based Reforms

“…Medicare Access and Children's Health Insurance Program Reauthorization Act embodies the belief that financial incentives can motivate providers to participate in value‐based reforms to improve quality and efficiency. Incentives are not a panacea, nor are all incentives financial (Phipps‐Taylor and Shortell ). Nonetheless, policy makers have at their disposal a very limited number of tools—most prominently, money and information (Glied ).…”