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Pay-for-Performance Programs to Improve Care

Pay-for-Performance Programs to Improve Care Hudson Health Plan
Hudson Valley Area, New York
Diabetes
Underserved minorities

Project


Health plan reaches out to enrollees and provides bonus payments to participating primary care providers for high-quality, patient-centered care.

Hudson sends members with diabetes a letter reminding them of the importance of an annual flu shot and enumerating the other key components of their diabetes care. Sometimes the letters are customized to indicate the particular services needed by the patient. A gift card is offered to members who complete a visit with their primary care physician.

Practices can earn up to $300 per patient annually for complying with care standards. There are several individual screenings (e.g., blood pressure, HbA1c, LDL cholesterol) and immunizations (e.g., pneumococcal and influenza) which have payments attached to them. Reaching certain health outcome levels, as well as achieving relative improvements are also incentivized. Provider payments and performance reports are delivered by Provider Relations representatives during an annual meeting where overall outcomes and opportunities for improvement are discussed.

Rationale


Pay-for-performance programs can improve outcomes for racial and ethnic minority patients, provided that they are designed to reward patient-centered care rather than population-wide results. Programs relying exclusively on population-wide outcome measures may encourage providers to avoid less adherent or sicker patients, exacerbating disparities or leaving them unchanged. The incentive amount is based on an estimate of provider effort needed, available resources, and prior studies investigating the magnitude of incentive needed to engage provider interest.

By encouraging the regular monitoring and testing of diabetic patients, this pay-for-performance program hopes to improve overall health and quality of care. Medium and long-term savings in emergency care and inpatient costs may be realized, while near-term costs of care and medications may increase. It is possible that any long-term benefits will accrue once patients are no longer members of the plan.

Summary Results


Providing a $10 financial incentive to patients for completing a primary care visit, and up to $300 per patient to primary care providers for complying with care standards, did not improve patient HbA1c levels and diabetes-related healthcare utilization (LDL testing, HbA1c testing, diabetes-related care).

Publications


Impact of a Pay for Performance Program to Improve Diabetes Care in the Safety Net
Preventive Medicine. 2012 Nov; 55 Suppl: S80-5.
Full Article (
subscription may be required)

Principal Investigators

  • Janet Sullivan, MD (Chief Medical Officer, Hudson Health Plan)
  • Meredith Rosenthal, PhD (Associate Professor, Harvard School of Public Health)