By JP Strapp
A recent article in the Annals of Internal Medicine, The Effects of Pay-for-Performance Programs on Health, Health Care Use, and Processes of Care: A Systemic Review, detailed the effects of pay-for-performance (P4P) programs on health outcomes, health care utilization, and processes of care. The authors concluded that there is no consistent positive association between P4P programs and improved health outcomes. While this systematic review is both thorough and noteworthy, we should not use this analysis to draw broad conclusions about value-based care. Based on TKG’s experience deeply entrenched in care delivery, there are two main reasons why this P4P review should not be correlated to the effectiveness of existing value-based care tactics.
First, it is important to reinforce that there are a number of elements that contribute to success in a value-based care environment. Financial incentives, such as P4P, are an important catalyst to help drive practice transformation but alone are insufficient. They should be part of an overall quality of care strategy, which includes elements of change management, physician and care team engagement, use of data for continuous quality improvement, and patient activation and engagement efforts. We have observed the successful application of these tactics impacting both outcomes and cost of care in the implementation of our Quality Blue Primary Care program for Blue Cross Blue Shield of Louisiana.
Additionally, we believe that it is important to further analyze the Quality and Outcomes Framework (QoF), a primary care performance management and P4P payment system implemented by the National Health Service (NHS) in the United Kingdom, from the perspective of the United States healthcare system. The QoF was a major component of the Annals of Internal Medicine review of P4P programs and has been the focus of many similar reports. The program design and rollout warrants further analysis to determine its applicability to value-based care imperatives in the United States. Why has the QoF been ineffective? Are there lessons to be learned to help ensure success in the United States market?
In summary, it is clear that value-based care delivery is extremely complex and can be analyzed from many different angles. As such, the Annals of Internal Medicine review is an important signal to ensure that several value-based care critical success factors are incorporated into process redesign and that these changes are properly and completely executed. At TKG, we believe this approach can help health systems achieve the Quadruple Aim measures that all healthcare stakeholders are seeking.