Awareness of Payment Reform: a Survey of Patients, Staff, and Providers in Safety Net Primary Care Clinics

  • Katherine Diaz VickeryEmail author
  • Becky R. Ford
  • Eileen M. Harwood
  • Katherine F. Guthrie
  • Mark Linzer
Concise Research Report


Payment reform has been increasing in the U.S. health care system in recent years. Reforms move away from fee-for-service toward value-based payments, or compensation per-patient tied to care quality goals.1 Value-based payment is hypothesized to achieve the quadruple aim—improved care quality at lower costs with more satisfied patients and providers.2

Value-based payment presents both opportunities and challenges for health care clinics that see majority low-income patients (i.e., the safety net). While offering flexibility to invest in services to address patients’ social needs,3 it may discourage care for costly populations.4 Although evidence suggests cost-savings of value-based payment models for low-income, complex populations,5 the study of payment reform has focused on regional impact and rarely details mechanisms of change at the clinic level. Previous measurement of engagement within value-based programs has depended on secondhand reports from leaders,6not...



We would like to acknowledge Melissa M. Adkins for help with data collection, management, and submission.

Funding Information

This paper was supported by a grant (no. 73615) from the Robert Wood Johnson Foundation.

Compliance with Ethical Standards

Conflict of Interest

Dr. Linzer works with AMA, Institute for Healthcare Improvement and the American College of Physicians, on clinician work life improvements. Dr. Guthrie reports that her husband owns stock in Merck and Express Scripts. The other authors report no conflicts.


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Copyright information

© Society of General Internal Medicine 2019

Authors and Affiliations

  1. 1.Hennepin HealthcareMinneapolisUSA
  2. 2.Hennepin Healthcare Research InstituteMinneapolisUSA
  3. 3.School of Public HealthUniversity of MinnesotaMinneapolisUSA
  4. 4.Allina Health, United Family MedicineSaint PaulUSA

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