title: Large performance incentives had the greatest impact on providers whose quality metrics were lowest at baseline.
abstract: This study examined the impact of Fairview Health Services' primary care provider compensation model, in which 40 percent of compensation was based on clinic-level quality outcomes. Fairview Health Services is a Pioneer accountable care organization in Minnesota. Using publicly reported performance data from 2010 and 2012, we found that Fairview's improvement in quality metrics was not greater than the improvement in other comparable Minnesota medical groups. An analysis of Fairview's administrative data found that the largest predictor of improvement over the first two years of the compensation model was primary care providers' baseline quality performance. Providers whose baseline performance was in the lowest tertile improved three times more, on average, across the three quality metrics studied than those in the middle tertile, and almost six times more than those in the top tertile. As a result, there was a narrowing of variation in performance across all primary care providers at Fairview and a narrowing of the gap in quality between providers who treated the highest-income patient panels and those who treated the lowest-income panels. The large quality incentive fell short of its overall quality improvement aim. However, the results suggest that payment reform may help narrow variation in primary care provider performance, which can translate into narrowing socioeconomic disparities.
authors.affiliation: Jessica Greene (jessgreene@gwu.edu) is a professor in the School of Nursing at the George Washington University, in Washington, D.C.
authors.forename: Jessica
authors.initials: J
authors.lastname: Greene
authors.affiliation: Judith H. Hibbard is a professor emerita and senior researcher in the Health Policy Research Group at the University of Oregon, in Eugene.
authors.forename: Judith H
authors.initials: JH
authors.lastname: Hibbard
authors.affiliation: Valerie Overton is vice president for quality and innovation at Fairview Medical Group, in Minneapolis, Minnesota.
authors.forename: Valerie
authors.initials: V
authors.lastname: Overton
mesh_terms: D060866:Accountable Care Organizations / Q000191:economics; D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D008910:Minnesota; D010816:Physician Incentive Plans / Q000191:economics*; D011320:Primary Health Care / Q000191:economics; D019984:Quality Indicators, Health Care / Q000191:economics*; D011787:Quality of Health Care; D012052:Reimbursement, Incentive
keywords: Physician Payment; Quality Of Care