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Table 3 Effects pay-for-performance on healthcare quality

From: Pay-for-performance in disease management: a systematic review of the literature

Incentive Study design (N) Year(s) data collection Relevant outcome measures Healthcare quality
Western New York Physician Incentive Program (WNY-P4P) [16] Pre-post test
Experimental group: patients (n = 624) whose physicians (n = 21) participated in P4P scheme
Control group: sample of diabetic patients from health plan
2002-2003 • Quality of care based on a composite score which was based on process and outcome measures. • Average of physician's composite scores increased 48% (baseline to end of project).
• 13 out of 21 physicians improved their average composite score enough to earn some level of financial reward.
• Of the 8 physicians not receiving reward, 6 improved their composite score.
Integrated Healthcare Association Pay-for-performance Program (IHA-P4P) [30] Cross-sectional analysis of linked 2006 clinical performance scores from IHA-P4P and survey data from the 2nd National Study of Physician Organizations among 108 California physician organizations. 2006 • Association between clinical performance and the use of chronic management processes
• Association between clinical performance and electronic medical record capabilities
• Association between clinical performance and participation in external quality improvement initiatives.
• Physician organizations investing more heavily in care management processes (e.g. patient registries, physician reminders and feedback, patient reminders and education) may achieve better performance scores.
• Use of organized quality improvement efforts (e.g. participation in QI program) may be associated with increased delivery of recommended care processes, which in the context of the study translated into better performance on the clinical measures that were rewarded in the P4P scheme.
Practice Incentive Program Diabetes Incentive (PIP-DI) [38] Retrospective study based on dataset from BEACH study (data from 100 consecutive encounters of 1000 GPs that are yearly randomly selected. Each encounter contains data on up to 4 problems treated, drugs prescribed, treatments conducted, referrals written and pathology).
N = 12187: 1. Treatment group 1: accredited practices that use IT for internet, prescribing and medical records; 2. Treatment group 2: practices that are accredited and do not use IT for internet, prescribing and medical records; 3. Control group: practices that are not accredited and do not use IT, for internet, prescribing and medical records.
April 2002-March 2007 from • Percentage of patients that received a glycosylated haemoglobin blood test during GP consult • PIP-DI increased probability of a HbA1c test being ordered by 20 percentage points.
• For patients from Aboriginal and Torres Straight Islander background the increase was more than 35 percentage points.
Practice Incentive Program Diabetes Incentive (PIP-DI) [37] Descriptive study based on semi structured face-to-face interviews (22 GP practices) 2003 • Implementation of components of diabetes cycle of care • Financial incentives may promote better clinical management. GPs claiming incentives were more likely to comply with all requirements than GPs that did not claim incentives.
External incentives (including financial incentives). [39] Cross-sectional study: telephone survey among 1104 physician organizations (PO) with 20 or more physicians 2000-2001 • Extent of use of organized CMPs on the basis of summary measure: PO care management index, external incentives (bonus from health plans, public recognition, better contracts with health plans) quality reporting to outside organization (HEDIS data, clinical outcome data, results of quality improvement projects, patient satisfaction data), IT use • External incentives and clinical IT were most strongly associated with CMP use.
• Use of the most strongly associated incentives (public recognition and better contracts for healthcare quality) was associated with use of 1.3 and 0.7 additional CMPs (significant).
• Receiving a bonus for scoring well on quality of care measures was not significantly associated with CMP use.
  1. Notes: BEACH = Bettering the Evaluation and Care of Health; CMP = care management processes; FFS = fee for services; HEDIS = Health Plan Employer Data and Information Set; PO = physician organization; P4P = pay-for-performance; QI = quality improvement.