Pay-for-performance in disease management: a systematic review of the literature

Simone R De Bruin,Caroline A Baan,Jeroen N Struijs

doi:10.1186/1472-6963-11-272

Simone R De Bruin, Caroline A Baan + Show 1 more

Open Access

https://doi.org/10.1186/1472-6963-11-272

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Abstract

BackgroundPay-for-performance (P4P) is increasingly implemented in the healthcare system to encourage improvements in healthcare quality. P4P is a payment model that rewards healthcare providers for meeting pre-established targets for delivery of healthcare services by financial incentives. Based on their performance, healthcare providers receive either additional or reduced payment. Currently, little is known about P4P schemes intending to improve delivery of chronic care through disease management. The objectives of this paper are therefore to provide an overview of P4P schemes used to stimulate delivery of chronic care through disease management and to provide insight into their effects on healthcare quality and costs.MethodsA systematic PubMed search was performed for English language papers published between 2000 and 2010 describing P4P schemes related to the implementation of disease management. Wagner's chronic care model was used to make disease management operational.ResultsEight P4P schemes were identified, introduced in the USA (n = 6), Germany (n = 1), and Australia (n = 1). Five P4P schemes were part of a larger scheme of interventions to improve quality of care, whereas three P4P schemes were solely implemented. Most financial incentives were rewards, selective, and granted on the basis of absolute performance. More variation was found in incented entities and the basis for providing incentives. Information about motivation, certainty, size, frequency, and duration of the financial incentives was generally limited. Five studies were identified that evaluated the effects of P4P on healthcare quality. Most studies showed positive effects of P4P on healthcare quality. No studies were found that evaluated the effects of P4P on healthcare costs.ConclusionThe number of P4P schemes to encourage disease management is limited. Hardly any information is available about the effects of such schemes on healthcare quality and costs.

Highlights

Pay-for-performance (P4P) is increasingly implemented in the healthcare system to encourage improvements in healthcare quality
A model that is perhaps best known from an international perspective, and that was used for this study to make disease management operational, is the Chronic Care Model (CCM) of Wagner et al [5,7]
The model suggests that disease management ideally comprises six interrelated de Bruin et al BMC Health Services Research 2011, 11:272 http://www.biomedcentral.com/1472-6963/11/272 components and that integration of these components is the key towards improving chronic care management [4]

Summary

Introduction

Pay-for-performance (P4P) is increasingly implemented in the healthcare system to encourage improvements in healthcare quality. The healthcare system, traditionally predominated by a re-active approach and consisting of highly specialized echelons, needs to be transformed to realize patient-centered chronic care in which problems like To deal with this challenge, policymakers and professionals introduced disease management programs ( referred to as e.g. case management, integrated care, managed care, and shared care) to enhance quality and continuity of care for the chronically ill. A model that is perhaps best known from an international perspective, and that was used for this study to make disease management operational, is the Chronic Care Model (CCM) of Wagner et al [5,7] This model can be considered as a guide towards improving management and coordination of chronic conditions. The model suggests that disease management ideally comprises six interrelated de Bruin et al BMC Health Services Research 2011, 11:272 http://www.biomedcentral.com/1472-6963/11/272 components (i.e. health care organization, community resources, self-management support, decision support, delivery system design, and clinical information system) and that integration of these components is the key towards improving chronic care management [4]

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