Provider and Patient Directed Financial Incentives to Improve Care and Outcomes for Patients with Diabetes
- 488 Downloads
Incentive programs directed at both providers and patients have become increasingly widespread. Pay-for-performance (P4P) where providers receive financial incentives to carry out specific care or improve clinical outcomes has been widely implemented. The existing literature indicates they probably spur initial gains which then level off or partially revert if incentives are withdrawn. The literature also indicates that process measures are easier to influence through P4P programs but that intermediate outcomes such as glucose, blood pressure, and cholesterol control are harder to influence, and the long-term impact of P4P programs on health is largely unknown. Programs directed at patients show greater promise as a means to influence patient behavior and intermediate outcomes such as weight loss; however, the evidence for long-term effects are lacking. In combination, both patient and provider incentives are potentially powerful tools but whether they are cost-effective has yet to be determined.
KeywordsDiabetes mellitus Reimbursement Incentives Pay for performance Economics Behavioral
Conflicts of interest: I.S. Lorincz: none; B.C.T. Lawson: none; J.A. Long: has received grant support from NIDDK.
Papers of particular interest, published recently, have been highlighted as • Of importance •• Of major importance
- 2.Johnson EJ, Goldstein D. Do defaults save lives? Sci Justice. 2003;302:1338–9.Google Scholar
- 3.Thaler RH, Mullainathan S. Behavioral economics. The Concise Encyclopedia of Economics. 2008. Available at: http://www.econlib.org/library/Enc/BehavioralEconomics.html. Accessed October 10, 2012.
- 7.•• Scott A, Sivey P, Ait Ouakrim D, et al. The effect of financial incentives on the quality of health care provided by primary care physicians. Cochrane Database of Syst Rev. 2011;9:CD008451. This Cochrane Review evaluates the impact of different financial interventions on the quality of care delivered by primary care physicians (PCPs). A total of 7 rigorously-designed studies published between 2000–2009 were evaluated; all studies were randomized controlled trials (RCTs), controlled before and after studies (CBA), or interrupted time series analyses (ITS). Three of the studies included diabetes specific metrics.Google Scholar
- 9.NHS website. Available at: http://www.qof.ic.nhs.uk/. Accessed October 2, 2012.
- 11.Quality and outcomes framework for 2012/13. Available at: http://www.nhsemployers.org/Aboutus/Publications/Documents/QOF_2012-13.pdf. Accessed October 2, 2012.
- 13.• Vaghela P, Ashwort M, Schofield P, Gulliford MC. Population intermediate outcomes of diabetes under pay-for-performance incentives in England from 2004 to 2008. Diabetes Care. 2009;32:427–9. An evaluation of diabetes-specific outcome metrics for 98 % of all English family practices. There was an improvement in all metrics after the initiation of QOF; however, data was only analyzed from 2004–2007, limiting the analysis.PubMedCrossRefGoogle Scholar
- 14.Hippisley-Cox J, Vinogradova Y, Coupland C. Time series analysis for selected clinical indicators from the quality and outcomes framework 2001-2006’, final report for the information centre, version 1.1, R22 HSCIC (2007). Available at: http://www.qresearch.org/Public_Documents/Time%20Series%20Analysis%20for%20selected%20clinical.pdf. Accessed October 2, 2012.
- 15.Hamilton FL, Bottle A, Vamos EP, et al. Impact of a pay-for-performance incentive scheme on age, sex, and socioeconomic disparities in diabetes management in UK primary care. J Ambul Care Manag. 2010;33:336–49.Google Scholar
- 21.Terry K. Pay for performance. How fast is it spreading? Available at: http://medicaleconomics.modernmedicine.com/memag/content/printContentPopup.jsp?id=190108. Accessed October 2, 2012.
- 28.CMS Fact Sheet. Available at: http://www.ntocc.org/Portals/0/PDF/Attachments/PublicPolicyUpdates/FSV-MPFS-2013-NPRM-20120706.pdf. Accessed October 2, 2012.
- 29.• Long JA, Jahnle EC, Richardson DM, Loewenstein G, Volpp KG. Peer mentoring and financial incentives to improve glucose control in African American veterans: A randomized trial. Ann Intern Med. 2012;156:416–24. Only published randomized control trial evaluating financial incentives to improve diabetic outcomes.PubMedGoogle Scholar
- 32.Cafazzo JA, Casselman M, Hamming N, Katzman DK, Palmert MR. Design of an mHealth app for the self-management of adolescent type 1 diabetes: a pilot study. J Med Internet Res. 2012;14:e70.Google Scholar
- 37.Kullgren JT, Loewenstein G, Troxel AB, et al. A randomized controlled trial of financial incentives to promote weight loss among obese employees: Presented at the Society of General Internal Medicine 2012 National Meeting, Orlando, FL.Google Scholar
- 42.Mitnick S, Snyder L, Hood VL. America College of Physicians Ethics, Professionalism and Human Rights Committee 2010 Position Paper. Ethical considerations for the use of patient incentives to promote personal responsibility for health: West Virginia medicaid and beyond. Available at: http://www.acponline.org/running_practice/ethics/issues/policy/personal_incentives.pdf. Accessed October 2nd, 2012.