Linking Provider Cost Curves and Care Delivery Practices: Implications for VBP

将提供者成本曲线与护理服务实践联系起来：对 VBP 的影响

• 批准号: 8423514
• 负责人: CHERYL DAMBERG
• 金额: $ 36.11万
• 依托单位: RAND CORPORATION
• 依托单位国家: 美国
• 财政年份: 2012
• 资助国家: 美国
• 起止时间: 2012-09-30 至 2014-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8423514
• 关键词: Accountability; Address; Affect; Behavioral; Budgets; California; Caring; Contracts; Data; Decision Making; Elements; Exposure to; Fostering; Funding; Goals; Growth; Health; Health Planning; Health Planning Organizations; Healthcare; Healthcare Market; Hospitals; Incentives; Individual; Interview; Lead; Link; Marketing; Measures; Medicare; Outcome; Patient Care; Pattern; Performance; Pharmacy facility; Physicians; Play; Policies; Policy Maker; Price; Process; Property; Provider; Quality of Care; Relative (related person); Reporting; Research; Resistance; Risk; Role; Secure; Services; Shapes; Signal Transduction; Site; Source; Structure; Time; Variant; Wages; Work; base; care delivery; cost; cost shifting; design; financial incentive; health care delivery; improved; organizational structure; payment; peer; programs; research study; response; trend

DESCRIPTION (provided by applicant): The large and unrelenting year-to-year growth in premiums (median increase of 14.6% a year among physician organizations in California) has led the Integrated Healthcare Association's multi-stakeholder group of health plans, purchasers, and physician organizations (POs) to replace their longstanding P4P program, which focused only on quality improvement, with a value-based purchasing (VBP) program that seeks to bend the cost curve and improve quality. The percent of revenue at risk will increase from the ~1% of capitation payment under P4P to ~8% of capitation payments under VBP. The program is slated to go into effect in 2013. Our study will evaluate the statewide IHA VBP plan, which has the potential to bend the cost curve, and will represent one of the largest VBP experiments in the U.S., targeting 200 POs that contract with six major health plans. By analyzing the behavioral response of POs to the new incentive structure, we will examine the critical national policy issue of whether, why, and under what circumstances VPB bends the cost curve. The outcomes we will evaluate longitudinally include changes in PO total costs of care (both cross-section and trend) and its component elements (pharmacy, ambulatory, hospital, and ancillary), quality performance, incentive payouts, and care delivery practices. Data for the project draws from multiple sources: total cost of care and quality performance data from IHA (derived from health plans and POs), incentive payments made to POs from health plans, and interview data that we collect from the POs. We will use statistical approaches to generate PO cost curves, investigate underlying cost drivers that explain various cost profiles, and examine PO behavioral responses to VBP that were associated with their ability to modify (or not modify) their cost trajectories ovr 4 years of exposure to the VBP. Cost curves provide information on cost levels as well as shape and orientation (i.e., trajectory), and we will track changes in PO cost curves over time. PUBLIC HEALTH RELEVANCE: Our study will evaluate the statewide Integrated Healthcare Association's value-based purchasing (VBP) plan, one of the largest VBP experiments in the U.S. that targets 200 physician organizations (POs). We will analyze the behavioral response of POs to the new incentive structure and examine whether, why, and under what circumstances VPB bends the cost curve. We will use statistical approaches to generate PO cost profiles, and identify care delivery processes associated with different PO cost profiles, controlling for market factors. The study examines whether and how PO cost profiles shift over time in response to the VBP and what factors are associated with the ability to bend the cost curve, which has implications for changing provider practices and broad use of VBP as a reform policy.

描述（由申请人提供）：保费的庞大且不懈的年度增长（加利福尼亚州的医生组织中的中位增长14.6％）导致综合医疗保健协会的多种健康计划，购买者和医生组织（POS）的成本仅替换了其长期以来的P4P购买，该计划的成本仅为P4P，该计划替代了有价值的P4P购买，该计划的成本仅为有价值的购买（VB）曲线并提高质量。处于风险的收入百分比将从P4P下的人力付款的约1％增加到VBP下的人力付款的〜8％。该计划将于2013年生效。我们的研究将评估全州IHA VBP计划，该计划有可能弯曲成本曲线，并将代表美国最大的VBP实验之一，以200张与六项主要健康计划合同的200 POS。通过分析POS对新的激励结构的行为反应，我们将研究重要的国家政策问题，即VPB是否会弯曲成本曲线。我们将纵向评估的结果包括PO总护理成本（横截面和趋势）及其组件元素（药房，卧床，医院和辅助）的变化，质量绩效，奖励支出和护理交付实践。该项目的数据来自多种来源：来自IHA的总护理和质量绩效数据（来自健康计划和POS），向POS支付的奖励付款以及我们从POS收集的访谈数据。我们将使用统计方法来生成PO成本曲线，调查解释各种成本概况的基本成本驱动因素，并检查对VBP的行为反应，这些响应与他们修改（或不修改）其成本轨迹OVR OVR OVR 4年接触VBP的能力。成本曲线提供有关成本水平以及形状和方向（即轨迹）的信息，我们将随着时间的推移跟踪PO成本曲线的变化。 公共卫生相关性：我们的研究将评估全州综合医疗协会基于价值的采购（VBP）计划，这是美国最大的VBP实验之一，该实验针对200个医师组织（POS）。我们将分析POS对新激励结构的行为反应，并检查VPB是否弯曲成本曲线的情况，为什么，为什么以及在什么情况下。我们将使用统计方法来产生PO成本概况，并确定与不同的PO成本配置文件相关的护理交付过程，以控制市场 因素。该研究研究了PO成本概况是否随着时间的流逝而随着时间的流逝而转变，以及与弯曲成本曲线的能力相关的哪些因素，这对改变提供商实践和广泛使用VBP作为改革政策具有影响。