Evaluating the Consequences of a Hypertension Management Incentive

Area of Science:

• Health Services Research
• Clinical Quality Improvement
• Cardiovascular Medicine

Background:

• Financial incentives tied to quality metrics are common but their real-world impact on patient care is complex.
• Isolating the effects of these incentives on clinical decisions and patient health outcomes is a persistent challenge.

Purpose of the Study:

• To assess the association between a physician-facing quality metric and financial incentive for hypertension control and subsequent clinical decisions and patient health outcomes.
• To evaluate the impact of financial incentives on hypertension management in a large US health system.

Main Methods:

• A quasi-experimental, difference-in-differences study design was employed in a large US health system.
• Compared outcomes at practices that adopted a hypertension control financial incentive versus those that did not, before and after incentive adoption (2021 vs. 2022-2023).
• Included patients aged 18-85 with diagnosed hypertension, analyzing blood pressure measurements, medication adjustments, and cardiovascular hospitalizations.

Main Results:

• The financial incentive was associated with a small increase in blood pressure remeasurement (1.9 pp) in the overall hypertensive population, with no significant changes in overall hypertension control, medication use, or cardiovascular hospitalizations.
• In patients with marginally high blood pressure (systolic 140-145 mm Hg), the incentive increased documented blood pressure control (4.1 pp) driven by increased remeasurement (5.6 pp).
• This subgroup also showed reduced antihypertensive medication dose adjustments (-1.1 pp) and a significant increase in 3-month hospitalization risk for stroke or acute coronary syndrome (0.25 pp), rising to 0.52 pp at 1 year.

Conclusions:

• The quality metric and financial incentive had minimal impact on measured outcomes for the general hypertensive population.
• For patients with marginally elevated blood pressure, the incentive led to increased documented control through selective measurement, decreased medication adjustments, and a concerning rise in cardiovascular hospitalizations.