Healthcare Revenue Cycle Management, ICD-10, Claims Reimbursement, Medicare, Medicaid

Value-Based Care News

Value-Based Incentives Enrich Accountable Care Organizations

Successful accountable care organizations experience high value, low costs, and strong care outcomes. Pay-for-performance incentives may make all three a reality.

By Jacqueline DiChiara

- Pay-for-performance incentives positively sway physician behavior when it comes to value-based care advancement, according to a new JAMA Pediatrics study. Financial incentives tied to value-based reimbursement advance basic health measures, say researchers. Pay-for-performance apparently ups pediatric performance levels among primary care physicians.

pay-for-performance accountable care organizations value-based reimbursement

The study assessed how pay-for-performance improves physician performance within an accountable care organization (ACO) delivering care to Medicaid children. Top findings on the reported success of financial incentives within pediatric ACOs likely represent the first available research of its kind, researchers state. 

Data was collected among nearly 3,000 physicians and over 323,000 patients from January of 2010 to December of 2013.

Study confirms 4 key findings

●        Measured improvements in factors like well care visits and immunizations.

●        Community physicians receiving P4P incentives achieved moderate but significant improvements in quality measures compared with other community physicians.

●        Hospital-employed primary care physicians who were targeted with non-incentive-based improvement efforts achieved greater performance improvements than community physicians receiving P4P incentives.

●        [Almost] all measures of health care quality that were examined showed improvement over the period, some to a significant degree.

“Pay for performance resulted in modest changes in physician performance in a pediatric ACO, but other interventions at the disposal of the ACO may have been even more effective. Further research is required to find methods to enhance quality improvements across large distributed pediatric health systems,” wrote researchers Sean Gleeson, MD, Kelly Kelleher, MD, MPH, and William Gardner, PhD.

Findings mirror past ACO findings

Earlier JAMA Pediatrics research from last February focused on the reported cost savings and care quality concerns of Partners for Kids (PFK), an Ohio-based pediatric ACO serving nearly 300,000 Medicaid eligible children.

Researchers asserted PFK was able to keep costs low and quality high. The pediatric ACO consequently increased its overall value in the healthcare system, they add.

PFK reportedly had lower cost growth than Medicaid fee-for-service programs and Medicaid managed care plans compared to other Ohio Medicaid plans.

From 2008 to 2013, PFK’s costs per monthly member allegedly only rose by $2.40 annually. In comparison, managed care plans reportedly increased at a rate of nearly $6.50 annually; Medicaid fee-for-service costs reportedly increased at over $16 annually.

“ACOs are responsible for healthcare costs and quality across a defined population. To succeed, the ACO must improve value by reducing costs while either maintaining or improving the quality and outcomes of care,” researchers wrote.

“Our data demonstrate the potential for an ACO to minimize the growth in cost of care for a pediatric population, all while maintaining or improving quality of care,” stated Kelleher, the study’s lead author and Vice President of Community Health Services at Nationwide Children’s.

Pediatric ACOs, he asserted, may potentially become efficient models of future healthcare reform initiatives.

“PFK delivered on the promise of the ACO to reduce the rate of health care cost growth while maintaining or improving the quality of care.”

“While an additional 30 million Americans will have access to health coverage under the Patient Protection and Affordable Care Act, the difficult work of creating a system of better care, better health and lower cost will occur gradually, through pilot projects designed to encourage innovation, improve effectiveness and reduce costs,” explained the study’s co-author Richard Brilli, MD, Chief Medical Officer at Nationwide Children’s.

“One of the primary vehicles through which the new law encourages such innovation is through provisions that establish Accountable Care Organizations in Medicare and for pediatrics, in Medicaid or CHIP.”


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