Evaluating a Pay-for-Performance Program for Medicaid Children in an Accountable Care Organization
Sean Gleeson1, Kelly Kelleher1, William Gardner2
1Partners for Kids, Columbus, Ohio2Department of Pediatrics, Ohio State University, Columbus3Nationwide Children's Hospital, Columbus, Ohio.
Insights
Pay for performance (P4P) showed modest improvements in pediatric primary care physicians within an accountable care organization (ACO). However, other interventions may be more effective for enhancing quality across pediatric health systems.
Area of Science:
- Pediatric Health Services Research
- Healthcare Quality Improvement
- Accountable Care Organizations
Background:
- Pay for performance (P4P) incentivizes healthcare providers for improved care processes and outcomes.
- P4P has not been previously studied in pediatric accountable care organizations (ACOs).
Purpose of the Study:
- To evaluate the impact of P4P on pediatric primary care physician performance within an ACO.
- To determine if P4P incentivizes improved quality of care for children.
Main Methods:
- Retrospective cohort study (2010-2013) using a differences-in-differences design.
- Analyzed data from 2966 physicians and 323,812 patients in a pediatric ACO serving Medicaid children.
- Compared performance on 21 Healthcare Effectiveness Data Information Set (HEDIS) measures between incentivized and non-incentivized physician groups.
Main Results:
- Incentivized physicians showed modest improvements in specific well-visit and immunization measures compared to non-incentivized community physicians.
- Employed physicians at a hospital demonstrated greater performance improvements than incentivized community physicians on several measures.
- The impact of P4P on overall pediatric performance within the ACO was limited.
Conclusions:
- P4P led to minor enhancements in physician performance within the pediatric ACO.
- Alternative interventions may offer greater potential for quality improvement in pediatric healthcare systems.
- Further research is needed to optimize quality enhancement strategies for large pediatric health networks.
Importance:
Pay for performance (P4P) is a mechanism by which purchasers of health care offer greater financial rewards to physicians for improving processes or outcomes of care. To our knowledge, P4P has not been studied within the context of a pediatric accountable care organization (ACO).
Objective:
To determine whether P4P promotes pediatric performance improvement in primary care physicians.
Design, Setting, And Participants:
This retrospective cohort study was conducted from January 1, 2010, to December 31, 2013. A differences-in-differences design was used to test whether P4P improved physician performance in an ACO serving Medicaid children. Data were obtained from 2966 physicians and 323,812 patients. Three groups of physicians were identified: (1) community physicians who received the P4P incentives, (2) nonincentivized community physicians, and (3) nonincentivized physicians employed at a hospital.
Intervention:
Pay for performance.
Main Outcomes And Measures:
Healthcare Effectiveness Data Information Set measure rates for preventive care, chronic care, and acute care primary care services. We examined 21 quality measures, 14 of which were subject to P4P incentives.
Results:
There were 203 incentivized physicians, 2590 nonincentivized physicians, and 173 nonincentivized hospital physicians. Among them, the incentivized community physicians had greater improvements in performance than the nonincentivized community physicians on 2 of 2 well visits (largest difference was for adolescent well care: odds ratio, 1.05; 99.88% CI, 1.02-1.08), 3 of 10 immunization-incentivized measures (largest difference was for inactivated polio vaccine: odds ratio, 1.14; 99.88% CI, 1.07-1.21), and 2 nonincentivized measures (largest difference was for rotavirus: odds ratio, 1.11; 99.88% CI, 1.04-1.18). The employed physician group at the hospital had greater improvements in performance than the incentivized community physicians on 8 of 14 incentivized measures and 1 of 7 nonincentivized measures (largest difference was for hepatitis A vaccine: odds ratio, 0.34; 99.88% CI, 0.31-0.37).
Conclusions And Relevance:
Pay for performance resulted in modest changes in physician performance in a pediatric ACO, but other interventions at the disposal of the ACO may have been even more effective. Further research is required to find methods to enhance quality improvements across large distributed pediatric health systems.
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