Practice strategies to improve primary care for chronic disease patients under a pay-for-value program

Dori Cross, Paige Nong, Christy Harris-Lemak, Genna R. Cohen, Ariel Linden, Julia Adler-Milstein

Research output: Contribution to journalArticle

Abstract

Background: Improving primary care for patients with chronic illness is critical to advancing healthcare quality and value. Yet, little is known about what strategies are successful in helping primary care practices deliver high-quality care for this population under value-based payment models. Methods: Double-blind interviews in 14 primary care practices in the state of Michigan, stratified based on whether they did (n = 7) or did not (n = 7) demonstrate improvement in primary care outcomes for patients with at least one reported chronic disease between 2010 and 2013. All practices participate in a statewide pay-for-performance program run by a large commercial payer. Using an implementation science framework to identify leverage points for effecting organizational change, we sought to identify, describe and compare strategies among improving and non-improving practices across three domains: (1) organizational learning opportunities, (2) approaches to motivating staff, and (3) acquisition and use of resources. Results: We identified 10 strategies; 6 were “differentiating” – that is, more prevalent among improving practices. These differentiating strategies included: (1) participation in learning collaboratives, (2) accessing payer tools to monitor quality performance, (3) framing pay-for-performance as a practice transformation opportunity, (4) reinvesting earned incentive money in equitable, practice-centric improvement, (5) employing a care manager, and (6) using available technical support from local hospitals and provider organizations to support performance improvement. Implementation of these strategies varied based on organizational context and relative strengths. Conclusions: Practices that succeeded in improving care for chronic disease patients pursued a mix of strategies that helped meet immediate care delivery needs while also creating new adaptive structures and processes to better respond to changing pressures and demands. These findings help inform payers and primary care practices seeking evidence-based strategies to foster a stronger delivery system for patients with significant healthcare needs.

Original languageEnglish (US)
Pages (from-to)30-37
Number of pages8
JournalHealthcare
Volume7
Issue number1
DOIs
StatePublished - Mar 1 2019

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Primary Health Care
Chronic Disease
Incentive Reimbursement
Quality of Health Care
Learning
Organizational Innovation
Evidence-Based Practice
Double-Blind Method
Motivation
Organizations
Interviews
Delivery of Health Care
Pressure
Population

Keywords

  • Complex care management
  • Primary care redesign
  • Qualitative research
  • Quality improvement

PubMed: MeSH publication types

  • Journal Article

Cite this

Practice strategies to improve primary care for chronic disease patients under a pay-for-value program. / Cross, Dori; Nong, Paige; Harris-Lemak, Christy; Cohen, Genna R.; Linden, Ariel; Adler-Milstein, Julia.

In: Healthcare, Vol. 7, No. 1, 01.03.2019, p. 30-37.

Research output: Contribution to journalArticle

Cross, Dori ; Nong, Paige ; Harris-Lemak, Christy ; Cohen, Genna R. ; Linden, Ariel ; Adler-Milstein, Julia. / Practice strategies to improve primary care for chronic disease patients under a pay-for-value program. In: Healthcare. 2019 ; Vol. 7, No. 1. pp. 30-37.
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abstract = "Background: Improving primary care for patients with chronic illness is critical to advancing healthcare quality and value. Yet, little is known about what strategies are successful in helping primary care practices deliver high-quality care for this population under value-based payment models. Methods: Double-blind interviews in 14 primary care practices in the state of Michigan, stratified based on whether they did (n = 7) or did not (n = 7) demonstrate improvement in primary care outcomes for patients with at least one reported chronic disease between 2010 and 2013. All practices participate in a statewide pay-for-performance program run by a large commercial payer. Using an implementation science framework to identify leverage points for effecting organizational change, we sought to identify, describe and compare strategies among improving and non-improving practices across three domains: (1) organizational learning opportunities, (2) approaches to motivating staff, and (3) acquisition and use of resources. Results: We identified 10 strategies; 6 were “differentiating” – that is, more prevalent among improving practices. These differentiating strategies included: (1) participation in learning collaboratives, (2) accessing payer tools to monitor quality performance, (3) framing pay-for-performance as a practice transformation opportunity, (4) reinvesting earned incentive money in equitable, practice-centric improvement, (5) employing a care manager, and (6) using available technical support from local hospitals and provider organizations to support performance improvement. Implementation of these strategies varied based on organizational context and relative strengths. Conclusions: Practices that succeeded in improving care for chronic disease patients pursued a mix of strategies that helped meet immediate care delivery needs while also creating new adaptive structures and processes to better respond to changing pressures and demands. These findings help inform payers and primary care practices seeking evidence-based strategies to foster a stronger delivery system for patients with significant healthcare needs.",
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