This study examines the combined impact of primary care organization participation in multiple healthcare delivery and payment reform models on care quality and value.
Study Overview
Problem: Multiple delivery and payment reform efforts seek to reduce healthcare costs and improve quality in the U.S. The impacts of these voluntary programs, including Medicare and Medicaid Electronic Health Record Incentive Programs (known as “Meaningful Use”), Patient-Centered Medical Home (PCMH) programs, and Accountable Care Organizations (ACOs), have each been studied. However, little is known about the cumulative impact of the participation by primary care organizations in multiple programs.
Main Objective: To better understand the patterns of participation by primary care organizations in care delivery and payment reform models, and the impact of participation in a combination of programs on care quality and value.
Approach: In this longitudinal observational study, the research team combined secondary datasets to examine the participation of primary care practices in Meaningful Use, PCMH, and/or ACO programs from 2009-2017, and looked at practice characteristics related to participation. The research team is also using Medicare claims data to assess the impact of model participation on the patient outcomes expected to improve under these programs, such as adherence to evidence-based care, reductions in avoidable hospitalizations, and reductions in spending.
Results: Out of over 56,000 primary care organizations in the study, 50% participated in one delivery or payment reform program over the study period, 13% participated in two programs; and 1% participated in all three.1 Primary care organizations that are larger, have more primary care providers, have younger providers, and those with more Medicare patients are more likely to participate in more than one program.1 In addition, participation in more than one program did not seem to provide synergistic benefits: combined participation in the three programs was associated with small increases in adherence to diabetes guidelines and lower spending on acute care, but participation in single programs was associated with similar benefits.2 The researchers suggest that greater synergistic impacts may be possible if future healthcare reform programs have better aligned requirements and goals.
Publications can be found here.
Primary Care Relevance
This research helps to better understand the impact of multiple delivery and payment reform efforts on primary care. Results can help guide the design and alignment of future policy efforts to improve healthcare quality and reduce costs.
AHRQ Primary Care Priority Area
Research to improve primary care, including regarding quality, access and affordability, the workforce, care delivery models, financing, digital healthcare, person-centeredness, and health equity.
Notes
1. Adler-Milstein, J., Linden, A., Bernstein, S., Hollingsworth, J., & Ryan, A. (2022). Longitudinal participation in delivery and payment reform programs among US Primary Care Organizations. Health services research 57(1), 47–55. https://doi.org/10.1111/1475-6773.13646.
2. Adler-Milstein, J., Linden, A., Hollingsworth, J. M., & Ryan, A. M. (2022). Association of primary care engagement in value-based reform programs with health services outcomes: participation and synergies. JAMA Health Forum 3(2), e220005. https://doi.org/10.1001/jamahealthforum.2022.0005.
