- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT02731716
Transforming Primary Care Payment in Hawaii
July 31, 2023 updated by: Amol Navathe, University of Pennsylvania
To design an innovative payment system that improves upon fee-for-service (FFS), incorporates behavioral economic principles, and improves work satisfaction among primary care physicians (PCPs) while improving quality and reducing health spending at the state level.
Second, to test the incremental effectiveness of two additional interventions: (1) shared financial incentives between physicians and poorly controlled diabetes and (2) social comparisons ranking physicians on quality metric performance and total cost of care.
Study Overview
Status
Active, not recruiting
Conditions
Intervention / Treatment
Detailed Description
The goal of this project is to transform the Hawaii Medical Service Association (HMSA) primary care provider payment model to better incentive population health while bending the increasing trend of health spending in the state.
Primary care and overall spending patterns will be studied to lay the foundation for a more rationally designed model.
This model deliberately shifts away from FFS and includes three components: 1) a risk-adjusted per-member, per-month (PMPM) base payment, 2) an enhanced quality incentive program with larger bonus amounts and 3) a total cost of care incentive at the PO level.
The aim is to build on the success of the Alternative Quality Contract (AQC) program implemented by Blue Cross Blue Shield (BCBS) of Massachusetts.
While the AQC is used as a starting point, the study introduces and tests a number of innovations using concepts from behavioral economics.
First, the move away from the FFS chassis to a PMPM-based capitated payment.
Second, 20% of the PMPM payment is at-risk based on metrics designed to increase engagement between HMSA and physicians and engagement with performance feedback.
Third, the number of metrics in the quality incentive program is drastically reduced from over 60 metrics to 10-12 per specialty.
Fourth, the scoring of quality incentives incorporates rewards for improvement, rather than exclusively attainment of thresholds, to activate physicians along the entire performance distribution.
In addition to implementing the new payment model, the initial experiment will include a test of two additional behavioral concepts: social comparisons for physicians and a shared incentive for physicians and poorly controlled diabetics tied to improve glycemic control.
Study Type
Interventional
Enrollment (Actual)
117
Phase
- Not Applicable
Participation Criteria
Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.
Eligibility Criteria
Ages Eligible for Study
18 years and older (Adult, Older Adult)
Accepts Healthy Volunteers
No
Description
Inclusion Criteria:
- HMSA physicians who are part of a Provider Organization that is participating in the payment transformation pilot.
Exclusion Criteria:
- Any physician who is not part of a participating Provider Organization.
Study Plan
This section provides details of the study plan, including how the study is designed and what the study is measuring.
How is the study designed?
Design Details
- Primary Purpose: Health Services Research
- Allocation: Randomized
- Interventional Model: Parallel Assignment
- Masking: None (Open Label)
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Experimental: New Payment Model
Providers in the first arm will no longer be paid based upon FFS, but on the new payment model.
Providers will receive a PMPM payment for attributed members, a quality incentive payment based upon attainment of sixteen quality metrics, and a possible bonus payment for savings in total cost of care at the provider organization level.
|
Providers will no longer be paid based upon FFS, but on the new payment model, which includes PMPM and quality incentives.
|
Experimental: Social Comparisons
Providers will no longer be paid based upon FFS, but on the new payment model.
Providers will receive a PMPM payment for attributed members, a quality incentive payment based upon attainment of sixteen quality metrics, and a possible bonus payment for savings in total cost of care at the provider organization level.
Providers will also receive weekly emails that will show comparisons of their own performance against their peers within the same provider organization on specific quality measures and total cost of care.
|
Providers will no longer be paid based upon FFS, but on the new payment model, which includes PMPM and quality incentives.
Providers will receive weekly emails showing comparisons in quality metrics and total cost of care.
They will be compared to other providers in their provider organization.
|
Experimental: A1c Member/Provider Incentive
Providers will no longer be paid based upon FFS, but on the new payment model, which includes a PMPM payment for attributed members, a quality incentive payment based upon attainment of quality metrics, and a possible bonus payment for savings in total cost of care.
Providers will also receive weekly emails that will show comparisons of their own performance against their peers within the same provider organization on specific quality measures and total cost of care.
There is also a shared incentive between the member and the provider.
The member incentive will be a payment made to diabetic patients with an A1C of greater than or equal to 9% who experience a reduction of at least 0.5%.
Each participating member and PCP can receive up to $75 per quarter for A1C reduction.
|
Providers will no longer be paid based upon FFS, but on the new payment model, which includes PMPM and quality incentives.
Providers will receive weekly emails showing comparisons in quality metrics and total cost of care.
They will be compared to other providers in their provider organization.
Attributed members and their PCPs will receive up to $75 for a reduction of a1c by 0.5% per quarter (2 quarters).
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Improvement in Provider Performance
Time Frame: 1 year
|
Provider performance on quality metrics will be compared across all three arms.
|
1 year
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Improvement in A1C among poorly controlled diabetics
Time Frame: 6 Months
|
A1c levels will be compared across all three arms to see if there is a reduction in a1c in arm 3.
|
6 Months
|
Primary Care Spending
Time Frame: 1 year
|
Primary care spending in primary care providers will be compared across all three arms.
|
1 year
|
Collaborators and Investigators
This is where you will find people and organizations involved with this study.
Sponsor
Collaborators
Study record dates
These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.
Study Major Dates
Study Start
April 1, 2016
Primary Completion (Actual)
December 1, 2017
Study Completion (Estimated)
July 1, 2025
Study Registration Dates
First Submitted
March 28, 2016
First Submitted That Met QC Criteria
April 1, 2016
First Posted (Estimated)
April 7, 2016
Study Record Updates
Last Update Posted (Actual)
August 2, 2023
Last Update Submitted That Met QC Criteria
July 31, 2023
Last Verified
July 1, 2023
More Information
Terms related to this study
Other Study ID Numbers
- 823981
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
NO
This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.
Clinical Trials on Diabetes
-
University of Colorado, DenverMassachusetts General Hospital; Beta Bionics, Inc.CompletedDiabetes Mellitus, Type 1 | Type 1 Diabetes | Diabetes type1 | Type 1 Diabetes Mellitus | Autoimmune Diabetes | Diabetes Mellitus, Insulin-Dependent | Juvenile-Onset Diabetes | Diabetes, Autoimmune | Insulin-Dependent Diabetes Mellitus 1 | Diabetes Mellitus, Insulin-Dependent, 1 | Diabetes Mellitus, Brittle | Diabetes Mellitus, Juvenile-Onset and other conditionsUnited States
-
Guang NingRecruitingType 2 Diabetes Mellitus | Type1 Diabetes Mellitus | Monogenetic Diabetes | Pancreatogenic Diabetes | Drug-Induced Diabetes Mellitus | Other Forms of Diabetes MellitusChina
-
University of Trás-os-Montes and Alto DouroCompletedType 2 Diabetes Mellitus | Diabetes-Related ComplicationsPortugal
-
Northern Care Alliance NHS Foundation TrustBrighter ABCompletedDiabetes type1 | Diabetes type2United Kingdom
-
VeraLight, Inc.InLight SolutionsUnknownGestational Diabetes | Insulin Dependent Diabetes | Non Insulin Dependent DiabetesUnited States
-
Garvan Institute of Medical ResearchWeizmann Institute of ScienceActive, not recruitingType 2 Diabetes Mellitus | Pre DiabetesAustralia
-
Taichung Veterans General HospitalNational Health Research Institutes, TaiwanRecruitingDiabetes Complications | Type 2 Diabetes | Maturity-Onset Diabetes of the Young (MODY)Taiwan
-
Oregon State UniversitySanofiCompletedType I or Type II Diabetes (Excludes Gestational Diabetes)
-
Peking Union Medical College HospitalUnknownType 2 Diabetes Mellitus | Type 1 Diabetes Mellitus | Gestational Diabetes Mellitus | Pancreatogenic Diabetes Mellitus | Pregestational Diabetes Mellitus | Diabetes Patients in Perioperative PeriodChina
-
University of RoehamptonRecruitingType2 Diabetes Mellitus | Pre DiabetesUnited Kingdom
Clinical Trials on New Payment Model
-
Oregon Health and Science UniversityRobert Wood Johnson Foundation; Agency for Healthcare Research and Quality... and other collaboratorsUnknown
-
University of PennsylvaniaHawaii Medical Service AssociationActive, not recruiting
-
Diakonhjemmet HospitalThe Research Council of NorwayCompletedKnee Osteoarthritis | Hip OsteoarthritisNorway
-
University of PittsburghCompletedPatient Centered CareUnited States
-
Sheba Medical CenterJuvenile Diabetes Research FoundationCompleted
-
University Hospital, GenevaFondation Privée des HUG; IF International FoundationNot yet recruitingRecovery | Psychiatric Hospitalization | CoercionSwitzerland
-
St. Petersburg State Pavlov Medical UniversityPirogov Russian National Research Medical University; Ministry of Health, Russian... and other collaboratorsUnknownStroke | Total Hip Replacement | AMIRussian Federation
-
University of DundeeCompletedCardiovascular Diseases
-
Kirby InstituteNot yet recruiting
-
Makerere UniversityBill and Melinda Gates FoundationActive, not recruiting