Paying physician group practices for quality: A statewide quasi-experiment

Conrad, Douglas A.; Grembowski, David; Perry, Lisa; Maynard, Charles; Rodríguez, Hector P.; Martin, Diane P.

doi:10.1016/j.hjdsi.2013.04.012

Cited by 6 publications

(12 citation statements)

References 26 publications

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“…16,18 Evidence of the effectiveness of marginal incentive payments for value is more mixed, however, and may depend on the size of the incentives. 25,26 Many payment reform efforts require significant changes in the care delivery and support systems, for instance, in the data-and claimsprocessing infrastructure, electronic health records (EHRs), and staff roles. But providers' limited ability to meet infrastructure demands for payment reform has made them resistant and hindered its implementation.…”

Section: Promise and Challenges Of Value-based Payment Reformmentioning

confidence: 99%

Emerging Lessons From Regional and State Innovation in Value‐Based Payment Reform: Balancing Collaboration and Disruptive Innovation

et al. 2014

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Policy Points:r Public and private purchasers must create a "burning bridge" of countervailing pressure that signals "no turning back" to fee-for-service in order to sustain the momentum for value-based payment.r Multi-stakeholder coalitions must establish a defined set of quality, outcomes, and cost performance measures and the interoperable information systems to support data collection and reporting of value-based payment schemes.r Anti-trust vigilance is necessary to find the "sweet spot" of competition and cooperation among health plans and health care providers.r Provider and health plan transparency of price and quality, supported by all-payer claims data, are critical in driving value-based payment innovation and cost constraint. Context:In recent decades, practitioners and policymakers have turned to value-based payment initiatives to help contain spending on health care and to improve the quality of care. The Robert Wood Johnson Foundation funded 7 grantees across the country to design and implement value-based, multistakeholder payment reform projects in 6 states and 3 regions of the United States. Methods:As the external evaluator of these projects, we reviewed documents, conducted Internet searches, interviewed key stakeholders, cross-validated The Milbank Quarterly, Vol. 92, No. 3, 2014 (pp. 568-623) Emerging Lessons From Innovation in Value-Based Payment Reform 569factual and narrative interpretation, and performed qualitative analyses to derive cross-site themes and implications for policy and practice. Findings:The nature of payment reform and its momentum closely reflects the environmental context of each project. Federal legislation such as the Patient Protection and Affordable Care Act and federal and state support for the development of the patient-centered medical home and accountable care organizations encourage value-based payment innovation, as do local market conditions for payers and providers that combine a history of collaboration with independent innovation and experimentation by individual organizations.Multistakeholder coalitions offer a useful facilitating structure for galvanizing payment reform. But to achieve the objectives of reduced cost and improved quality, multistakeholder payment innovation must overcome such barriers as incompatible information systems, the technical difficulties and transaction costs of altering existing billing and payment systems, competing stakeholder priorities, insufficient scale to bear population health risk, providers' limited experience with risk-bearing payment models, and the failure to align care delivery models with the form of payment. Conclusions:From the evidence adduced in this article, multistakeholder, value-based payment reform requires a trusted, widely respected "honest broker" that can convene and maintain the ongoing commitment of health plans, providers, and purchasers. Change management is complex and challenging, and coalition governance requires flexibility and stable leadership, as market conditions and stakeholder enga...

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Section: Promise and Challenges Of Value-based Payment Reformmentioning

confidence: 99%

Emerging Lessons From Regional and State Innovation in Value‐Based Payment Reform: Balancing Collaboration and Disruptive Innovation

et al. 2014

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“…7, [11][12][13]15,27,28 Some authors have recommended that incentives constitute at least 10 percent of compensation. Since Fairview's payment model allocated four times that level to quality incentives, we examined whether improvement was substantially larger than that observed in previous research or compared to other delivery systems in Minnesota.…”

Section: Introductionmentioning

confidence: 99%

Large Performance Incentives Had The Greatest Impact On Providers Whose Quality Metrics Were Lowest At Baseline

2015

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This study examined the impact of Fairview Health Services' primary care provider compensation model, in which 40 percent of compensation was based on clinic-level quality outcomes. Fairview Health Services is a Pioneer accountable care organization in Minnesota. Using publicly reported performance data from 2010 and 2012, we found that Fairview's improvement in quality metrics was not greater than the improvement in other comparable Minnesota medical groups. An analysis of Fairview's administrative data found that the largest predictor of improvement over the first two years of the compensation model was primary care providers' baseline quality performance. Providers whose baseline performance was in the lowest tertile improved three times more, on average, across the three quality metrics studied than those in the middle tertile, and almost six times more than those in the top tertile. As a result, there was a narrowing of variation in performance across all primary care providers at Fairview and a narrowing of the gap in quality between providers who treated the highest-income patient panels and those who treated the lowest-income panels. The large quality incentive fell short of its overall quality improvement aim. However, the results suggest that payment reform may help narrow variation in primary care provider performance, which can translate into narrowing socioeconomic disparities.

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“…The 12 papers were published between 2004–2017, seven were conducted in the United States of America [ 32 – 38 ], four in the UK [ 39 – 42 ] and one in Canada [ 43 ]. One study reported on an asthma-only scheme [ 36 ], three focused on diabetes-only schemes [ 32 , 33 , 43 ] and the remaining eight looked at diabetes within a multiple condition scheme [ 34 , 35 , 37 – 42 ].…”

Section: Resultsmentioning

confidence: 99%

“…Beck’s [ 32 ] participants had volunteered to take part in the intensive case management programme and the control group were those who had chosen not to, creating a non-randomised, biased sample biased by willingness to participate. Conrad’s [ 34 ] participating group were selected by the Health Insurer, Fagan’s [ 35 ] participants were selected by the managed care organisation as they had a “leadership which was willing to champion the proposed quality improvement initiative” and Gulliford’s [ 39 ] participants were a self-selected group that agreed to participate in an evaluation of diabetes care. Due to the nature of financial incentive schemes, participant blinding is not an option so that allocation concealment was an important source of bias.…”

Section: Resultsmentioning

confidence: 99%

The impact of financial incentives on the implementation of asthma or diabetes self-management: A systematic review

et al. 2017

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IntroductionFinancial incentives are utilised in healthcare systems in a number of countries to improve quality of care delivered to patients by rewarding practices or practitioners for achieving set targets.ObjectivesTo systematically review the evidence investigating the impact of financial incentives for implementation of supported self-management on quality of care including: organisational process outcomes, individual behavioural outcomes, and health outcomes for individuals with asthma or diabetes; both conditions with an extensive evidence base for self-management.MethodsWe followed Cochrane methodology, using a PICOS search strategy to search eight databases in November 2015 (updated May 2017) including a broad range of implementation methodologies. Studies were weighted by robustness of methodology, number of participants and the quality score. We used narrative synthesis due to heterogeneity of studies.ResultsWe identified 2,541 articles; 12 met our inclusion criteria. The articles were from the US (n = 7), UK (n = 4) and Canada (n = 1). Measured outcomes were HbA1c tests undertaken and/or the level achieved (n = 10), written action plans for asthma (n = 1) and hospital/emergency department visits (n = 1). Three of the studies were part of a larger incentive scheme including many conditions; one focused on asthma; eight focussed on diabetes. In asthma, the proportion receiving ‘perfect care’ (including providing a written action plan) increased from 4% to 88% in one study, and there were fewer hospitalisations/emergency department visits in another study. Across the diabetes studies, quality-of-care/GP performance scores improved in three, were unchanged in six and deteriorated in one.ConclusionsResults for the impact of financial incentives for the implementation of self-management were mixed. The evidence in diabetes suggests no consistent impact on diabetic control. There was evidence from a single study of improved process and health outcomes in asthma. Further research is needed to confirm these findings and understand the process by which financial incentives may impact (or not) on care.Trial registrationProtocol registration number: CRD42016027411

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Paying physician group practices for quality: A statewide quasi-experiment

Cited by 6 publications

References 26 publications

Emerging Lessons From Regional and State Innovation in Value‐Based Payment Reform: Balancing Collaboration and Disruptive Innovation

Emerging Lessons From Regional and State Innovation in Value‐Based Payment Reform: Balancing Collaboration and Disruptive Innovation

Large Performance Incentives Had The Greatest Impact On Providers Whose Quality Metrics Were Lowest At Baseline

The impact of financial incentives on the implementation of asthma or diabetes self-management: A systematic review

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