The Impact of Pay-for-Performance Incentives for Primary Care Practices to Improve Patient Experience

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Slide 1

The Impact of Pay-for-Performance Incentives for Primary Care Practices to Improve Patient Experience

Lise Rybowski
The Severyn Group
Yale CAHPS® Team

AHRQ Annual Meeting
September 10, 2012

Slide 2

Agenda for Presentation

• Context for this case study within the CAHPS program.
• Goals of the study: What we hoped to learn.
• Overview and key components of the pay-for-performance program.
• Study methodology.
• What we found.
• Key takeaways.

Slide 3

Context for this Case Study

• CAHPS surveys as measures of patients' experiences with care:
  • Patient-provider communication.
  • Access to care and information.
  • Courtesy and respect from office staff.
• Use of the CAHPS Clinician & Group Survey:
  • To inform health care consumers/patients when choosing providers.
  • To inform health care providers about their own performance.

Slide 4

Research Questions

How does a program designed to drive and support improvements in patient experience with primary care affect the participating medical practices?

• What did the practices do to improve their performance?
• What challenges did the practices face?
• What contributed to the results? What could have made this program more effective?

Slide 5

Overview of Contractual Relationships

Image: A chart describes the relationships between the various parties:

• Health Plan and Other Payers →
• Large Provider Network (and Public Report) → Education and Consulting Service →
  • Regional Organizations:
    • Practice 1.
    • Practice 2.
    • Practice 3.
    • Practice 4.
  • Regional Organizations:
    • Practice 5.
    • Practice 6.
    • Practice 7.
    • Practice 8.
  • Regional Organizations:
    • Practice 9.
    • Practice 10.
    • Practice 11.
    • Practice 12.
  • Regional Organizations:
    • Practice 13.
    • Practice 14.
    • Practice 15.
    • Practice 16.

Slide 6

Key Components of the Pay-for-Performance Program

• Multi-year withhold.
• Payment tied to performance on multiple measures.
• Biennial measurement of patient experience.
• Free educational and consulting support from internal center.
• Challenging goal: No one paid unless "group" meets specified objectives.

Slide 7

Methods

• Interviews with leadership in participating organizations:
  • Health plan.
  • Provider network.
  • Internal center supporting quality improvement.
  • Public reporting organization.
• Interviews with practice leaders: administrative and clinical
  • Seven practice sites.
  • One practice representing four sites.

Slide 8

What Happened? The Bottom Line

• Overall, patients' experiences with primary care improved.
• But not enough: Didn't achieve the goal needed to qualify for payment.

Slide 9

Did the Inventive Work?

Not likely:

• Practice leaders not aware of incentive to improve patient experience.
• Practice leaders not aware of ongoing goal of improving patient experience at the network level.
• Practice leaders not paying attention to public report.
• Mixed awareness and use of free services to support QI efforts.

Slide 10

Major Challenges Posed by P4P Program

• Nature of the incentive: How much was at stake? For whom?
• Timing of the performance assessment.
• Questions about the measure.
• Performance of individual practice versus all participants.
• Inadequate communication.

Slide 11

More Challenges for Practices

• Multiple demands for attention; competing priorities:
  • Access versus communication/office staff.
• Nature of the requirements.
• Inadequate infrastructure, skills to support quality improvement efforts.

Slide 12

Key Takeaways and Implications for Policymakers

• Have to compensate for the multiple layers between the payer (source of incentive) and the people responsible for improving patient experience (recipients of incentive).
• Need clear and ongoing communication about:
  • Merits of the measures.
  • Goals.
  • What's at stake and for whom.
  • Available educational and consulting support.
• Need to consider context and competing priorities: Are there ways to coordinate?