Does Pay for Performance Improve Cardiovascular Care in a “Real-World” Setting?

Chen, Judy Ying; Tian, Haijun; Juárez, Deborah Taira; Yermilov, Irina; Braithwaite, R. Scott; Hodges, Krista A.; Legorreta, Antonio P.; Chung, Richard

doi:10.1177/1062860611398303

Cited by 8 publications

(11 citation statements)

References 27 publications

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“…34 A pay-for-performance model in the United Kingdom was used to reward providers based on the percentage of patients with cholesterol counts below a threshold. 35 Similarly, medication adherence could be used as a performance measure for emerging care models such as accountable care organizations and patient-centered medical homes.…”

Section: Discussionmentioning

confidence: 99%

The Large Social Value Resulting From Use Of Statins Warrants Steps To Improve Adherence And Broaden Treatment

et al. 2012

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Statins are considered a clinically important breakthrough for the treatment of cardiovascular disease. However, their social value at the US population level has not previously been studied. From an economic perspective, social value measures the quantity of resources--in monetary terms--that society would be willing to give up in order to retain the survival gains resulting from statin therapy. Using combined population and clinical data, this article calculates statins' social value to consumers, or the value of survival benefits above actual payments for the drug, and to producers, or drug revenues, for the period 1987-2008. National survey data suggest that statin therapy reduced low-density lipoprotein levels by 18.8 percent, which translated into roughly 40,000 fewer deaths, 60,000 fewer hospitalizations for heart attacks, and 22,000 fewer hospitalizations for strokes in 2008. For people starting statin therapy in 1987-2008, consumers captured $947.4 billion (76 percent) of the total social value of the survival gains. Even greater consumer benefits could be achieved in the future if statins were prescribed in full compliance with cholesterol guidelines and patients adhered to prescribed regimens. In addition, statin costs are declining because of patent expirations. Policy makers should consider interventions at the patient and provider levels to encourage both therapy for untreated patients with high cholesterol and greater adherence after therapy is initiated.

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Section: Discussionmentioning

confidence: 99%

The Large Social Value Resulting From Use Of Statins Warrants Steps To Improve Adherence And Broaden Treatment

et al. 2012

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“…8 Even when improvements in processes of care are shown, they are often modest9 10 and lacking in apparent impacts on patient outcomes 11. Although several studies have found associations between the introduction of pay for performance schemes and reduced hospital admissions,12 13 14 complications,15 16 and mortality,17 a recent systematic review concluded that the effect of pay for performance schemes on patient outcomes was largely uncertain 18. Part of the reason for this uncertainty may be that the impact of pay for performance schemes depends on their context and design,19 20 21 22 and this has led to experimentation with new and more innovative types of contract 23…”

Section: Introductionmentioning

confidence: 99%

Effect of a national primary care pay for performance scheme on emergency hospital admissions for ambulatory care sensitive conditions: controlled longitudinal study

Harrison

Dusheiko

Sutton

et al. 2014

BMJ

119

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Objective To estimate the impact of a national primary care pay for performance scheme, the Quality and Outcomes Framework in England, on emergency hospital admissions for ambulatory care sensitive conditions (ACSCs).Design Controlled longitudinal study.Setting English National Health Service between 1998/99 and 2010/11. Participants Populations registered with each of 6975 family practices in England.Main outcome measures Year specific differences between trend adjusted emergency hospital admission rates for incentivised ACSCs before and after the introduction of the Quality and Outcomes Framework scheme and two comparators: non-incentivised ACSCs and non-ACSCs.Results Incentivised ACSC admissions showed a relative reduction of 2.7% (95% confidence interval 1.6% to 3.8%) in the first year of the Quality and Outcomes Framework compared with ACSCs that were not incentivised. This increased to a relative reduction of 8.0% (6.9% to 9.1%) in 2010/11. Compared with conditions that are not regarded as being influenced by the quality of ambulatory care (non-ACSCs), incentivised ACSCs also showed a relative reduction in rates of emergency admissions of 2.8% (2.0% to 3.6%) in the first year increasing to 10.9% (10.1% to 11.7%) by 2010/11. ConclusionsThe introduction of a major national pay for performance scheme for primary care in England was associated with a decrease in emergency admissions for incentivised conditions compared with conditions that were not incentivised. Contemporaneous health service changes seem unlikely to have caused the sharp change in the trajectory of incentivised ACSC admissions immediately after the introduction of the Quality and Outcomes Framework. The decrease seems larger than would be expected from the changes in the process measures that were incentivised, suggesting that the pay for performance scheme may have had impacts on quality of care beyond the directly incentivised activities.

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“…1 In the United States, studies have also shown mostly negative results, and concerns have arisen concerning deselection of complicated or low-income patients. [2][3][4][5] Why might P4P fail? There are many potential factors, but one major cause is the complexity of effecting behavior change.…”

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confidence: 99%

Rewarding Healthy Behaviors--Pay Patients for Performance

Wu¹

2012

The Annals of Family Medicine

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Despite a considerable investment of resources into pay for performance, preliminary studies have found that it may not be signifi cantly more effective in improving health outcome measures when compared with voluntary quality improvement programs. Because patient behaviors ultimately affect health outcomes, I would propose a novel pay-for-performance program that rewards patients directly for achieving evidence-based health goals. These rewards would be in the form of discounts towards co-payments for doctor's visits, procedures, and medications, thereby potentially reducing cost and compliance issues. A pilot study recruiting patients with diabetes or hypertension, diseases with clear and objective outcome measures, would be useful to examine true costs, savings, and health outcomes of such a reward program. Offering incentives to patients for reaching health goals has the potential to foster a stronger partnership between doctors and patients and improve health outcomes. INTRODUCTION In an effort to improve health care quality, insurance companies and Medicare initiated pay-for-performance (P4P) programs that reward health care clinicians for achieving certain evidence-based performance measures. In theory, it seems as though this system should help improve patient health. Yet, a recent study of 500,000 patients in the United Kingdom found that P4P did not result in better hypertension outcomes over a 7-year period, despite input of $2.8 billion from the government.1 In the United States, studies have also shown mostly negative results, and concerns have arisen concerning deselection of complicated or low-income patients. 2-5Why might P4P fail? There are many potential factors, but one major cause is the complexity of effecting behavior change. P4P tries to improve health care based on the assumption that a single physician can successfully change the health-related behaviors of 1,000 patients. Indeed, physician counseling can help prime a patient for change, 6 but ultimately it is the patient's behavior change that will directly affect health outcomes. A program that rewards patients fi nancially for reaching measurable health goals has the potential to reduce issues of cost and compliance, 2 important obstacles to quality care. I therefore propose a new system: pay patients for performance (PP4P). WHAT PP4P WOULD LOOK LIKE 262 PAY PAT IEN T S F O R P ER F O R M A NC Ebe in the form of health care credits, which can be used toward discounts on medications, health insurance, procedures, and co-payments. The credits can be added onto the patients' health cards at their doctor's visits. When patients achieve preventive health goals, such as getting cancer-screening examinations at recommended intervals, they also earn credits. When they exercise, they can wear a heart rate monitor and bring the recordings to their employer to add credits to their health card, so employers can share administrative costs of updating the cards. By rewarding preventive care and healthy behaviors, this system will also ben...

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Does Pay for Performance Improve Cardiovascular Care in a “Real-World” Setting?

Cited by 8 publications

References 27 publications

The Large Social Value Resulting From Use Of Statins Warrants Steps To Improve Adherence And Broaden Treatment

The Large Social Value Resulting From Use Of Statins Warrants Steps To Improve Adherence And Broaden Treatment

Effect of a national primary care pay for performance scheme on emergency hospital admissions for ambulatory care sensitive conditions: controlled longitudinal study

Rewarding Healthy Behaviors--Pay Patients for Performance

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