title: Sustained participation in a pay-for-value program: impact on high-need patients.
abstract: OBJECTIVE
  To assess whether multi-year engagement by primary care practices in a pay-for-value program was associated with improved care for high-need patients.
  
  
  METHODS
  Longitudinal cohort study of 17,443 patients with 2 or more conditions who were assigned to primary care providers (PCPs) within 1582 practices that did and did not continuously participate in Blue Cross Blue Shield of Michigan's pay-for-value program (the Physician Group Incentive Program [PGIP]) between 2010 and 2013.
  
  
  METHODS
  We used generalized linear mixed models, with patient-level random effects, to assess the relationship between whether practices continuously participated in PGIP and those practices' cost, use, and quality outcomes (derived from claims data) over a 4-year period. For most outcomes, models estimated the odds of any cost and utilization, as well as the amount of cost and utilization contingent on having any.
  
  
  RESULTS
  High-need patients whose PCPs continuously participated in PGIP had lower odds of 30- and 90-day readmissions (odds ratio [OR], 0.65 and 0.63, respectively; P <.01 for both) over time compared with patients with PCPs who did not continuously participate. They also appeared to have lower odds of any emergency department visits (OR, 0.88; P <.01) and receive higher overall quality (1.6% higher; P <.01), as well as medication management-specific quality (3.0% higher; P <.01). We observed no differences in overall medical-surgical cost.
  
  
  CONCLUSIONS
  Continuous PCP participation in a pay-for-value program was associated with lower use and improved quality over time, but not lower costs, for high-need patients. National policy efforts to engage PCPs in pay-for-value reimbursement is therefore likely to achieve some intended outcomes but may not be sufficient to deliver care that is of substantially higher value.
authors.affiliation: University of Michigan, 1415 Washington Heights, Ann Arbor, MI 48108. E-mail: dacross@umich.edu.
authors.forename: Dori A
authors.initials: DA
authors.lastname: Cross
authors.forename: Genna R
authors.initials: GR
authors.lastname: Cohen
authors.forename: Christy
authors.initials: C
authors.lastname: Harris Lemak
authors.forename: Julia
authors.initials: J
authors.lastname: Adler-Milstein
mesh_terms: D054598:Blue Cross Blue Shield Insurance Plans; D015897:Comorbidity; D005260:Female; D006301:Health Services Needs and Demand; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008824:Michigan; D017146:Models, Organizational; D019982:Organizational Case Studies; D011320:Primary Health Care / Q000191:economics*; D058996:Quality Improvement; D011787:Quality of Health Care; D012052:Reimbursement, Incentive; D062505:Value-Based Purchasing