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The impact of the diabetes management incentive on diabetes-related services: evidence from Ontario, Canada

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Abstract

Financial incentives have been introduced in several countries to improve diabetes management. In Ontario, the most populous province in Canada, a Diabetes Management Incentive (DMI) was introduced to family physicians practicing in patient enrollment models in 2006. This paper examines the impact of the DMI on diabetes-related services provided to individuals with diabetes in Ontario. Longitudinal health administrative data were obtained for adults diagnosed with diabetes and their family physicians. The study population consisted of two groups: DMI group (patients enrolled with a family physician exposed to DMI for 3 years), and comparison group (patients affiliated with a family physician ineligible for DMI throughout the study period). Diabetes-related services was measured using the Diabetic Management Assessment (DMA) billing code claimed by patient’s physician. The impact of DMI on diabetes-related services was assessed using difference-in-differences regression models. After adjusting for patient- and physician-level characteristics, patient fixed-effects and patient-specific time trend, we found that DMI increased the probability of having at least one DMA fee code claimed by patient’s physician by 9.3% points, and the probability of having at least three DMA fee codes claimed by 2.1% points. Subgroup analyses revealed the impact of DMI was slightly larger in males compared to females. We found that Ontario’s DMI was effective in increasing the diabetes-related services provided to patients diagnosed with diabetes in Ontario. Financial incentives for physicians help improve the provision of targeted diabetes-related services.

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Notes

  1. http://www.anl.com/MOHGUIDE/00%20Diabetes%20Management%20Incentive%20-%20April%202006.pdf.

References

  1. World Health Organization.: Diabetes (2017). http://www.who.int/en/news-room/fact-sheets/detail/diabetes. Accessed 10 Aug 2018

  2. Statistics Canada. Table 13-10-0096-07 Diabetes, by age group (2018). https://www150.statcan.gc.ca/t1/tbl1/en/tv.action?pid=1310009607. Accessed 11 Aug 2018

  3. International Diabetes Federation. IDF Diabetes Atlas, 8th edn. International Diabetes Federation, Brussels, Belgium (2017)

    Google Scholar 

  4. Diabetes Canada.: Diabetes in Canada. 2018

  5. Lippi Bruni, M., Nobilio, L., Ugolini, C.: Economic incentives in general practice: the impact of pay-for-participation and pay-for-compliance programs on diabetes care. Health Policy 90, 140–148 (2009)

    Article  Google Scholar 

  6. Dusheiko, M., Doran, T., Gravelle, H., Fullwood, C., Roland, M.: Does higher quality of diabetes management in family practice reduce unplanned hospital admissions? Health Serv. Res. 46, 27–46 (2011). https://doi.org/10.1111/j.1475-6773.2010.01184.x

    Article  PubMed  PubMed Central  Google Scholar 

  7. Laberge, M., Kone Pefoyo, A.J.: Assessing the effectiveness of policies to reduce diabetes hospitalizations before and after the reforms of physician payment and primary care organization in British Columbia and Alberta. Can. J. Diabetes 40, 406–410 (2016)

    Article  Google Scholar 

  8. Kantarevic, J., Kralj, B.: Link between pay for performance incentives and physician payment mechanisms: evidence from the diabetes management incentive in Ontario. Health Econ. 22, 1417–1439 (2013)

    Article  Google Scholar 

  9. Lee, T.-T., Cheng, S.-H., Chen, C.-C., Lai, M.-S.: A pay-for-performance program for diabetes care in Taiwan: a preliminary assessment. Am J Manag Care 16, 65–69 (2010)

    PubMed  Google Scholar 

  10. Scott, A., Schurer, S., Jensen, P.H., Sivey, P.: The effects of an incentive program on quality of care in diabetes management. Health Econ. 18, 1091–1108 (2009)

    Article  Google Scholar 

  11. Harrison, M.J., Dusheiko, M., Sutton, M., Gravelle, H., Doran, T., Roland, M.: Effect of a national primary care pay for performance scheme on emergency hospital admissions for ambulatory care sensitive conditions: controlled longitudinal study. BMJ 349, g6423 (2014)

    Article  Google Scholar 

  12. Vamos, E.P., Pape, U.J., Bottle, A., Hamilton, F.L., Curcin, V., Ng, A., et al.: Association of practice size and pay-for-performance incentives with the quality of diabetes management in primary care. CMAJ 183, E809–E816 (2011)

    Article  Google Scholar 

  13. Chen, J.Y., Tian, H., Taira Juarez, D., Hodges, K.A., Brand, J.C., Chung, R.S., et al.: The effect of a PPO pay-for-performance program on patients with diabetes. Am J Manag Care 16, e11–e19 (2010)

    PubMed  Google Scholar 

  14. Chen, C.-C., Cheng, S.-H.: Does pay-for-performance benefit patients with multiple chronic conditions? Evidence from a universal coverage health care system. Health Policy Plan 31, 83–90 (2016)

    Article  Google Scholar 

  15. Cheng, S.-H., Lee, T.-T., Chen, C.-C.: A longitudinal examination of a pay-for-performance program for diabetes care. Med. Care 50, 109–116 (2012). https://doi.org/10.1097/MLR.0b013e31822d5d36

    Article  PubMed  Google Scholar 

  16. Huang, Y.-C., Lee, M.-C., Chou, Y.-J., Huang, N.: Disease-specific pay-for-performance programs: do the P4P effects differ between diabetic patients with and without multiple chronic conditions? Med. Care 54, 977–983 (2016)

    Article  Google Scholar 

  17. Chien, A.T., Eastman, D., Li, Z., Rosenthal, M.B.: Impact of a pay for performance program to improve diabetes care in the safety net. Prev. Med. (Baltim) 55(Suppl), S80–S85 (2012). https://doi.org/10.1016/j.ypmed.2012.05.004

    Article  Google Scholar 

  18. Kiran, T., Victor, J.C., Kopp, A., Shah, B.R., Glazier, R.H.: The relationship between financial incentives and quality of diabetes care in Ontario, Canada. Diabetes Care 35, 1038–1046 (2012)

    Article  Google Scholar 

  19. Lavergne, M.R., Law, M.R., Peterson, S., Garrison, S., Hurley, J., Cheng, L., et al.: Effect of incentive payments on chronic disease management and health services use in British Columbia, Canada: interrupted time series analysis. Health Policy (New York) 122, 157–164 (2018). https://doi.org/10.1016/J.HEALTHPOL.2017.11.001

    Article  Google Scholar 

  20. Lin, T.-Y., Chen, C.-Y., Huang, Y.T., Ting, M.-K., Huang, J.-C., Hsu, K.-H.: The effectiveness of a pay for performance program on diabetes care in Taiwan: a nationwide population-based longitudinal study. Health Policy 120, 1313–1321 (2016)

    Article  Google Scholar 

  21. Hutchison, B., Glazier, R.: Ontario’s primary care reforms have transformed the local care landscape, but a plan is needed for ongoing improvement. Health Aff. 32, 695–703 (2013). https://doi.org/10.1377/hlthaff.2012.1087

    Article  Google Scholar 

  22. Jaakkimainen, R.L., Barnsley, J., Klein-Geltink, J., Kopp, A., Glazier, R.H.: Did changing primary care delivery models change performance? A population based study using health administrative data. BMC Fam. Pract. 12, 44 (2011)

    Article  Google Scholar 

  23. Office of the Auditor General of Ontario.: The 2016 Annual Report of the Office of the Auditor General of Ontario: Physicians billing. 2016

  24. Ministry of Health and Long-term Care.: Diabetes Management Incentive. 2006

  25. Ontario Ministry of Health and Long-Term Care. Diabetes Management Incentive and enhancements to after hours (Q012A & Q016A). 2009

  26. Ministry of Health and Long Term Care.: Schedule of benefits physician services under the Health Insurance Act (Effective 2016). 2015

  27. Ontario Ministry of Health and Long-Term Care.: Billing & payment guide for Blended Salary Model (BSM) physicians. 2012

  28. Ontario Ministry of Health and Long-Term Care:. INFOBulletin—keeping health care providers informed of payment, policy or program changes. 2015

  29. Ministry of Health and Long Term Care. Schedule of Benefits Physician Services Under the Health Insurance Act Ministry of Health (Effective April 1, 2020). 2020

  30. Waterloo Wellington Diabetes.: Diabetes billing codes. n.d

  31. Petrosyan, Y., Bai, Y.Q., Koné Pefoyo, A.J., Gruneir, A., Thavorn, K., Maxwell, C.J., Bronskill, S.E., Wodchis, W.P.: The relationship between diabetes care quality and diabetes-related hospitalizations and the modifying role of comorbidity. Can. J. Diabetes 41, 17–25 (2017). https://doi.org/10.1016/j.jcjd.2016.06.006

    Article  PubMed  Google Scholar 

  32. Hux, J.E., Ivis, F., Flintoft, V., Bica, A.: Diabetes in Ontario: determination of prevalence and incidence using a validated administrative data algorithm. Diabetes Care 25, 512–516 (2002). https://doi.org/10.2337/DIACARE.25.3.512

    Article  PubMed  Google Scholar 

  33. Kiran, T., Victor, J.C., Kopp, A., Shah, B.R., Glazier, R.H.: The relationship between primary care models and processes of diabetes care in Ontario. Can. J. Diabetes 38, 172–178 (2014)

    Article  Google Scholar 

  34. Postal CodeOM Conversion File (PCCF): Reference Guide. 2017. doi:Statistics Canada Catalogue no. 92-154-G

  35. Wilkins, R.: PCCF + Version F user’s guide: Automated geographic coding based on the Statistics Canada Postal Code Conversion Files: Including postal codes through July 2009. 2010

  36. Matheson, F.I., Dunn, J.R., Smith, K.L.W., Moineddin, R., Glazier, R.H.: Ontario Marginalization Index user guide version 1.0. 2012

  37. Matheson, F.: 2011 Ontario Marginalization Index: User guide. 2017

  38. Matheson, F.I., Dunn, J.R., Smith, K.L.W., Moineddin, R., Glazier, R.H.: Development of the Canadian Marginalization Index: a new tool for the study of inequality. Can. J. Public Health 103, S12–S16 (2012)

    Article  Google Scholar 

  39. The Johns Hopkins University. Johns Hopkins ACG® System n.d. https://www.hopkinsacg.org/. Accessed 22 Nov 2017

  40. Manitoba Centre for Health Policy. Concept: Adjusted Clinical Groups® (ACG®) - Overview 2015. http://mchp-appserv.cpe.umanitoba.ca/viewConcept.php?conceptID=1304#a_references. Accessed 22 Nov 2017

  41. Kiran, T., Kopp, A., Moineddin, R., Glazier, R.H.: Longitudinal evaluation of physician payment reform and team-based care for chronic disease management and prevention. CMAJ 187, E494–E502 (2015)

    Article  Google Scholar 

  42. Stukel, T.A., Glazier, R.H., Schultz, S.E., Guan, J., Zagorski, B.M., Gozdyra, P., et al.: Multispecialty physician networks in Ontario. Open Med 7, e40–e55 (2013)

    PubMed  PubMed Central  Google Scholar 

  43. Horowitz, J.L., Manski, C.F.: Nonparametric analysis of randomized experiments with missing covariate and outcome data. J. Am. Stat. Assoc. 95, 77–84 (2000). https://doi.org/10.2307/2669526

    Article  Google Scholar 

  44. Kang, H.: The prevention and handling of the missing data. Korean J Anesthesiol. 64, 402–406 (2013). https://doi.org/10.4097/kjae.2013.64.5.402

    Article  PubMed  PubMed Central  Google Scholar 

  45. Park, H.M.: Practical guides to panel data modeling: A step by step analysis using Stata. In: Public management and policy analysis program, graduate school of international relations, pp. 1–52. International University of Japan (2011)

  46. Li, J., Hurley, J., DeCicca, P., Buckley, G.: Physician response to pay-for-performance: evidence from a natural experiment. Health Econ. 23, 962–978 (2014). https://doi.org/10.1002/hec.2971

    Article  PubMed  Google Scholar 

  47. Correia, S.: A feasible estimator for linear models with multi-way fixed effects. Duke University Preliminary Version (2016)http://scorreia.com/research/hdfe.pdf. Accessed 10 Aug 2018

  48. Vogeli, C., Shields, A.E., Lee, T.A., Gibson, T.B., Marder, W.D., Weiss, K.B., et al.: Multiple chronic conditions: prevalence, health consequences, and implications for quality, care management, and costs. J. Gen. Intern. Med. 22(Suppl 3), 391–395 (2007). https://doi.org/10.1007/s11606-007-0322-1

    Article  PubMed  PubMed Central  Google Scholar 

  49. Schoen, C., Osborn, R., How, S.K.H., Doty, M.M., Peugh, J.: In chronic condition: experiences of patients with complex health care needs, in eight countries, 2008. Health Aff. 28, w1–w16 (2009). https://doi.org/10.1377/hlthaff.28.1.w1

    Article  Google Scholar 

  50. Struijs, J.N., Baan, C.A., Schellevis, F.G., Westert, G.P., van den Bos, G.A.M.: Comorbidity in patients with diabetes mellitus: impact on medical health care utilization. BMC Health Serv. Res. 6, 84 (2006). https://doi.org/10.1186/1472-6963-6-84

    Article  PubMed  PubMed Central  Google Scholar 

  51. Boyd, C.M., Darer, J., Boult, C., Fried, L.P., Boult, L., Wu, A.W.: Clinical practice guidelines and quality of care for older patients with multiple comorbid diseases: implications for pay for performance. JAMA 294, 716 (2005). https://doi.org/10.1001/jama.294.6.716

    Article  CAS  PubMed  Google Scholar 

  52. Tinetti, M.E., Bogardus, S.T., Agostini, J.V.: Potential pitfalls of disease-specific guidelines for patients with multiple conditions. N. Engl. J. Med. 351, 2870–2874 (2004). https://doi.org/10.1056/NEJMsb042458

    Article  CAS  PubMed  Google Scholar 

  53. Vimalananda, V.G., Miller, D.R., Palnati, M., Christiansen, C.L., Fincke, B.G.: Gender disparities in lipid-lowering therapy among veterans with diabetes. Women’s Heal Issues 21, S176–S181 (2011). https://doi.org/10.1016/j.whi.2011.04.009

    Article  Google Scholar 

  54. Rossi, M.C., Cristofaro, M.R., Gentile, S., Lucisano, G., Manicardi, V., Mulas, M.F., et al.: Sex disparities in the quality of diabetes care: biological and cultural factors may play a different role for different outcomes: a cross-sectional observational study from the AMD Annals initiative. Diabetes Care 36, 3162–3168 (2013). https://doi.org/10.2337/DC13-0184

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  55. Chin, M.H., Drum, M.L., Guillen, M., Rimington, A., Levie, J.R., Kirchhoff, A.C., et al.: Improving and sustaining diabetes care in community health centers with the health disparities collaboratives. Med. Care 45, 1135–1143 (2007). https://doi.org/10.1097/MLR.0b013e31812da80e

    Article  PubMed  Google Scholar 

  56. Eijkenaar, F., Emmert, M., Scheppach, M., Schöffski, O.: Effects of pay for performance in health care: a systematic review of systematic reviews. Health Policy (New York) 110, 115–130 (2013). https://doi.org/10.1016/j.healthpol.2013.01.008

    Article  Google Scholar 

  57. Van Herck, P., De Smedt, D., Annemans, L., Remmen, R., Rosenthal, M.B., Sermeus, W.: Systematic review: effects, design choices, and context of pay-for-performance in health care. BMC Health Serv. Res. 10, 247 (2010). https://doi.org/10.1186/1472-6963-10-247

    Article  PubMed  PubMed Central  Google Scholar 

  58. Somé, N.H., Devlin, R.A., Mehta, N., Zaric, G., Li, L., Shariff, S., et al.: Production of physician services under fee-for-service and blended fee-for-service: evidence from Ontario, Canada. Health Econ 28, 1418–1434 (2019). https://doi.org/10.1002/hec.3951

    Article  PubMed  Google Scholar 

  59. Rossi, M.C., Lucisano, G., Pintaudi, B., Bulotta, A., Gentile, S., Scardapane, M., et al.: The complex interplay between clinical and person-centered diabetes outcomes in the two genders. Health Qual. Life Outcomes 15, 41 (2017). https://doi.org/10.1186/s12955-017-0613-0

    Article  PubMed  PubMed Central  Google Scholar 

  60. Pintaudi, B., Lucisano, G., Gentile, S., Bulotta, A., Skovlund, S.E., Vespasiani, G., et al.: Correlates of diabetes-related distress in type 2 diabetes: findings from the benchmarking network for clinical and humanistic outcomes in diabetes (BENCH-D) study. J. Psychosom. Res. 79, 348–354 (2015). https://doi.org/10.1016/j.jpsychores.2015.08.010

    Article  PubMed  Google Scholar 

  61. Mcgovern MP, Williams DJ, Hannaford PC, Taylor MW, Lefevre KE, Boroujerdi MA, et al. Introduction of a new incentive and target-based contract for family physicians in the UK: good for older patients with diabetes but less good for women? 2008;25:1083–9. https://doi.org/10.1111/j.1464-5491.2008.02544.x

  62. Austin, P.C., van Walraven, C.: The Mortality Risk Score and the ADG score: two points-based scoring systems for the Johns Hopkins Aggregated Diagnosis Groups (ADGs) to predict mortality in a general adult population cohort in Ontario, Canada. Med Care 49, 940–947 (2011). https://doi.org/10.1097/MLR.0b013e318229360e

    Article  PubMed  PubMed Central  Google Scholar 

  63. Baltagi, B.H.: Econometric Analysis of Panel Data, 3rd edn. Wiley, West Sussex, England (2005)

    Google Scholar 

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Acknowledgements

We thank two anonymous reviewers of this journal for their constructive feedback and suggestions for improvement. Funding for this research by the Canadian Institutes of Health Research operating grant (MOP–130,354) and Early Researcher Award by the Ontario Ministry of Research and Innovation is gratefully acknowledged. Thaksha would like to acknowledge the Western Graduate Research Scholarship at the University of Western Ontario. This study was undertaken at the ICES Western site. ICES is funded by an annual grant from the Ontario Ministry of Health and Long-Term Care (MOHLTC). Core funding for ICES Western is provided by the Academic Medical Organization of Southwestern Ontario (AMOSO), the Schulich School of Medicine and Dentistry (SSMD), Western University, and the Lawson Health Research Institute (LHRI). The opinions, results and conclusions are those of the authors and are independent from the funding sources. No endorsement by ICES, AMOSO, SSMD, LHRI, CIHR, or the MOHLTC is intended or should be inferred. We thank Lihua Li for pulling out the data from ICES databases used in this study.

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Authors and Affiliations

  1. Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON, N6A 5C1, Canada

    Thaksha Thavam, Amardeep Thind, Gregory S. Zaric & Sisira Sarma

  2. Department of Economics, University of Ottawa, Ottawa, ON, Canada

    Rose Anne Devlin

  3. Ivey School of Business, University of Western Ontario, London, ON, Canada

    Gregory S. Zaric

  4. ICES, Toronto, ON, Canada

    Sisira Sarma

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  1. Thaksha Thavam
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Correspondence to Sisira Sarma.

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The use of data in this study was authorized under Section 45 of Ontario’s Personal Health Information Protection Act, which does not require review by a Research Ethics Board. None of the authors has any conflicts of interest to declare.

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Thavam, T., Devlin, R.A., Thind, A. et al. The impact of the diabetes management incentive on diabetes-related services: evidence from Ontario, Canada. Eur J Health Econ 21, 1279–1293 (2020). https://doi.org/10.1007/s10198-020-01216-6

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