Transforming Primary Care Payment in Hawaii

Diabetes Clinical Trial

Official title:

Transforming Primary Care Payment in Hawaii

Clinical Trial Details — Status: Active, not recruiting

Administrative data

• NCT number: NCT02731716
• Other study ID #: 823981
• Status: Active, not recruiting
• Phase: N/A
• Start date: April 2016
• Est. completion date: July 2025

Study information

• Verified date: July 2023
• Source: University of Pennsylvania
• Contact: n/a
• Is FDA regulated: No
• Study type: Interventional

Clinical Trial Summary

To design an innovative payment system that improves upon fee-for-service (FFS), incorporates behavioral economic principles, and improves work satisfaction among primary care physicians (PCPs) while improving quality and reducing health spending at the state level. Second, to test the incremental effectiveness of two additional interventions: (1) shared financial incentives between physicians and poorly controlled diabetes and (2) social comparisons ranking physicians on quality metric performance and total cost of care.

Description:

The goal of this project is to transform the Hawaii Medical Service Association (HMSA) primary care provider payment model to better incentive population health while bending the increasing trend of health spending in the state. Primary care and overall spending patterns will be studied to lay the foundation for a more rationally designed model. This model deliberately shifts away from FFS and includes three components: 1) a risk-adjusted per-member, per-month (PMPM) base payment, 2) an enhanced quality incentive program with larger bonus amounts and 3) a total cost of care incentive at the PO level. The aim is to build on the success of the Alternative Quality Contract (AQC) program implemented by Blue Cross Blue Shield (BCBS) of Massachusetts. While the AQC is used as a starting point, the study introduces and tests a number of innovations using concepts from behavioral economics. First, the move away from the FFS chassis to a PMPM-based capitated payment. Second, 20% of the PMPM payment is at-risk based on metrics designed to increase engagement between HMSA and physicians and engagement with performance feedback. Third, the number of metrics in the quality incentive program is drastically reduced from over 60 metrics to 10-12 per specialty. Fourth, the scoring of quality incentives incorporates rewards for improvement, rather than exclusively attainment of thresholds, to activate physicians along the entire performance distribution. In addition to implementing the new payment model, the initial experiment will include a test of two additional behavioral concepts: social comparisons for physicians and a shared incentive for physicians and poorly controlled diabetics tied to improve glycemic control.

Recruitment information / eligibility

• Status: Active, not recruiting
• Enrollment: 117
• Est. completion date: July 2025
• Est. primary completion date: December 2017
• Accepts healthy volunteers: No
• Gender: All
• Age group: 18 Years and older

Eligibility

Inclusion Criteria:

• HMSA physicians who are part of a Provider Organization that is participating in the payment transformation pilot.

Exclusion Criteria:

• Any physician who is not part of a participating Provider Organization.

Related Conditions & MeSH terms

• Diabetes

Intervention

Behavioral:
• New Payment Model
Providers will no longer be paid based upon FFS, but on the new payment model, which includes PMPM and quality incentives.
• Social Comparisons
Providers will receive weekly emails showing comparisons in quality metrics and total cost of care. They will be compared to other providers in their provider organization.
• A1c Member/Provider Incentive
Attributed members and their PCPs will receive up to $75 for a reduction of a1c by 0.5% per quarter (2 quarters).

Locations

Country	Name	City	State
n/a

Sponsors (2)

Lead Sponsor	Collaborator
University of Pennsylvania	Hawaii Medical Service Association

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	Improvement in Provider Performance	Provider performance on quality metrics will be compared across all three arms.	1 year
Secondary	Improvement in A1C among poorly controlled diabetics	A1c levels will be compared across all three arms to see if there is a reduction in a1c in arm 3.	6 Months
Secondary	Primary Care Spending	Primary care spending in primary care providers will be compared across all three arms.	1 year