Basing Medical Payment on Patient Behavior Frustrates Primary Care Physicians

Judith Hibbard, Ph.D. Senior Researcher, Health Policy Research Group University of OregonMedicalResearch.com Interview with:
Judith Hibbard, Ph.D.
Senior Researcher, Health Policy Research Group
University of Oregon

MedicalResearch: What is the background for this study? What are the main findings?

Dr. Hibbard: Two important trends are happening in health care today:

1) Policies which move away from paying for volume and toward paying for value; and

2) The emphasis on patient engagement and the need for the patient to play a key part in the care process. Because so many quality outcomes are determined to a large extent by patient behaviors, there is an implied assumption that if you pay primary care clinicians (PCPs) more for better quality outcomes, they will also try to engage the patient as a necessary partner in reaching quality targets. That is, there is a tacit assumption that clinicians will naturally engage patients if you incentivize them on the quality metrics. We had an opportunity to examine the soundness of this assumption, when we conducted a study of primary care clinicians whose compensation was based 40% on their performance of quality metrics.

The findings show that the vast majority of clinicians did not invest their efforts in patient engagement and activation, when trying to maximize their income under this model. They put their efforts in other areas. However, a year later they were very frustrated that their income was influenced by patient behaviors. This was their greatest frustration with the compensation model, and they indicated that “patient’s unwillingness to change their behavior” as the greatest barrier to achieving their quality goals.

MedicalResearch: What should clinicians and patients take away from your report?

Dr. Hibbard:  Many Primary Care Providers were at a loss as how to support patient behavior change and patient activation. Yet to reach quality goals it will be necessary to help support patients in a way that enables them to take ownership and increases their capacity to become better self-managers. In the new health care environment where value will be linked more closely with payment, Primary Care Providers and their clinical teams may need to acquire new skills in this area. In addition new tools and organizational supports will also be needed.

Citation:

Does Compensating Primary Care Providers to Produce Higher Quality Make Them More or Less Patient Centric

Hibbard JH1, Greene J2, Sacks R2, Overton V3.

Med Care Res Rev. 2015 May 11. pii: 1077558715586291. [Epub ahead of print]

 

MedicalResearch.com Interview with:, & Judith Hibbard, Ph.D. (2015). Basing Medical Payment on Patient Behavior Frustrates Primary Care Physicians MedicalResearch.com