RAND Corporation, 1776 Main St, Santa Monica, CA 90407. Email:
Am J Manag Care. 2019 Feb 1;25(2):e26-e32.
To understand physician organization (PO) responses to financial incentives for quality and total cost of care among POs that were exposed to a statewide multipayer value-based payment (VBP) program, and to identify challenges that POs face in advancing the goals of VBP.
Semistructured qualitative interviews and survey.
We drew a stratified random sample of 40 multispecialty California POs (25% of the POs that were eligible for incentives). In-person interviews were conducted with physician leaders and a survey was administered on actions being taken to reduce costs and redesign care and to discuss the challenges to improving value. We performed a thematic analysis of interview transcripts to identify common actions taken and challenges to reducing costs.
VBP helps to promote care delivery transformation among POs, although efforts varied across organizations. Investments are occurring primarily in strategies to control hospital costs and redesign primary care, particularly for chronically ill patients; specialty care redesign is largely absent. Physician payment incentives for value remain small relative to total compensation, with continued emphasis on productivity. Challenges cited include the lack of a single enterprisewide electronic health records platform for information exchange, limited ability to influence specialists who were not exclusive to the organization, lack of payer cost and utilization data to manage costs, inability to recoup care redesign investments given the small size of VBP incentives, and lack of physician cost awareness.
Transformation could be advanced by strengthening financial incentives for value; engaging specialists in care redesign and delivering value; enhancing partnerships among POs, hospitals, and payers to align quality and cost actions; strengthening information exchange across providers; and applying other strategies to influence physician behavior.
了解医生组织 (PO) 对质量和总医疗成本的财务激励措施的反应，这些激励措施是在全州范围内多付款人基于价值的支付 (VBP) 计划下向 PO 提供的，并确定 PO 在推进 VBP 目标方面面临的挑战。
半结构化定性访谈和调查。
我们从有资格获得激励措施的 40 家加利福尼亚多专业 PO 中抽取了一个分层随机样本（25%的 PO）。对医生领导进行了面对面访谈，并进行了一项关于降低成本和重新设计护理以及讨论改善价值的挑战的调查。我们对访谈记录进行了主题分析，以确定降低成本的常见措施和挑战。
VBP 有助于促进 PO 中的医疗服务提供转型，尽管各个组织的努力有所不同。投资主要集中在控制医院成本和重新设计初级保健的策略上，特别是针对慢性病患者；专业护理重新设计基本上不存在。与总薪酬相比，医生对价值的支付激励仍然很小，并且仍然强调生产力。引用的挑战包括缺乏用于信息交换的单一企业级电子健康记录平台、对非组织独家的专家的影响力有限、缺乏用于管理成本的付款人和利用数据、由于 VBP 激励措施规模较小而无法收回护理重新设计投资，以及缺乏医生成本意识。
通过加强对价值的财务激励措施、让专家参与护理重新设计和提供价值、加强 PO、医院和付款人之间的合作伙伴关系以协调质量和成本措施、加强提供者之间的信息交换以及应用其他策略来影响医生行为，可以推进转型。
