Data and Outcomes - Local/Private Insurance

Local/Private Data and Outcomes Literature


(339) Johnson, RM et al. Outcomes of a Seven Practice Pilot in a Pay-for-Performance (P4P)-Based Program in Pennsylvania. Journal of Racial and Ethnic Health Disparities. 2015 March 1;2(1):139-148.

PMID: 25893158


  • Evaluation of the impact of seven Pennsylvania P4P pilot programs on racial and ethnic minority patient outcomes with regards to six-month interventions for hypertension, diabetes, and pediatric asthma.
  • Patient medical records were reviewed to determine how interventions impacted BMI, diet and exercise, smoking, visit compliance, blood pressure, sodium intake and weight management, medication reconciliation, HbA1c, lipid profile and anti-inflammatory medications.
  • Significant improvements were shown in all seven practices and 13/19 interventions

Significance to Literature:

Support for P4P program effects on racial and ethnic minority patient outcomes, especially in interventions related to education, discussion, and patient medical documentations


(342) Lemak, C et al. Michigan’s Fee-For-Value Physician Incentive Program Reduces Spending And Improves Quality in Primary Care. Health Affairs. 2015 Apr;34(4):645-52. doi: 10.1377/hlthaff.2014.0426

PMID: 25847648


  • Examination of Blue Cross Blue Shield of Michigan’s Physician Group Incentive Program, a “fee-for-value” reimbursement model, from 2008-2011 for more than three million beneficiaries in over 11,000 practices
  • 1.1% lower total spending for adults and 5.1% lower total spending for children
  • Equal or improved performance on 11/14 quality measures

Significance to Literature:

Supportive evidence for models that incentivize quality, cost-reduced care within a fee-for-service framework.



Key Article

(408) Asch et al. Effect of Financial Incentives to Physicians, Patients, or Both on Lipid Levels: A Randomized Clinical Trial. JAMA. 2015 Nov 10;314(18):1926-35. doi: 10.1001/jama.2015.14850.

PMID: 26547464


  • Multicenter cluster randomized clinical trial comparing the effect of physician financial incentives, patient financial incentives, shared physician and patient incentives, and no incentives on reducing levels of low-density lipoprotein cholesterol (LDL-C) in high cardiovascular risk patients
  • Patients were deemed eligible based on Framingham-Risk Scores, LDL-C levels, and presence of coronary artery disease
  • Primary care physicians and patients were randomly assigned to each group. Physicians were each eligible to receive up to $1024 annually per patient and patients could receive up to the same amount via entrance into daily lotteries based on medication adherence
  • Only patients in the shared physician/patient incentive group achieved significantly reduced LDL-C levels compared to the control group after 12-month intervention
  • Shared incentive average was 126.4 mg/dl compared to 136.4 mg/dl in the control group

Significance to Literature:

Promising evidence for physician and patient shared incentives in P4P primary schemes and an indication for further research



(410) Bastian et al. The Impact of Pay-for-Performance Program on Central-Line Associated Blood Stream Infections in Pennsylvania. Hosp Top. 2016 Jan-Mar;94(1):8-14. doi: 10.1080/00185868.2015.1130542.

PMID: 26980202


  • Data from 149 Pennsylvania hospitals was utilized to evaluate the effect of Highmark’s Quality Blue (QB) Hospital P4P Program on central-line associated bloodstream infections (CLABSI)
  • Highmark Inc. is an independent licensee of the Blue Cross and Blue Shield Association based in Pittsburgh, PA serving 5.2 million members
  • Those hospitals participating in the QB program had 0.727 times the CLABSI as those that did not participate in any P4P program (i.e. only 72.7% of the CLABSIs that non-P4P hospitals had)
  • Hospitals participating for four or more years in the program had 3.13 fewer CLABSI per year compared to newer P4P participants

Significance to Literature:

Quality Blue P4P program in PA showed clinically significant improvement in CLABSI outcomes



(423) Linda et al. Strategies for Improving Vaccine Delivery: A Cluster-Randomized Trial. Pediatrics. 2016 Jun;137(6). pii: e20154603. doi: 10.1542/peds.2015-4603. Epub 2016 May 10.

PMID: 27244859


  • Comparison of a P4P program versus a web-based quality improvement learning program in their impact on pediatric immunization coverage for pediatric practices across the U.S.
  • There was no difference in percentage of all needed vaccines received (PANVR) or immunization up-to-date (UTD) status
  • PANVR did not significantly increase for patients within either group over the course of the study, but UTD did reach significant improvement in the virtual learning program practices
  • Practices in both arms reported a similar average (six to seven) of new vaccine QI activities initiated during the intervention period

Significance to Literature:

Standard approaches to P4P or virtual learning collaboratives may be rather ineffective at impacting immunization coverage. However, they may spur clinics to initiate internal QI programs directed at immunizations.



(426) Bunkers et al. Value-based physician compensation: a link to performance improvement. Healthc Financ Manage. 2016 Mar;70(3):52-8.

PMID: 27183759


  • Mayo Clinic Health System (MCHS) implemented a value-based physician compensation model in 2014 across parts of Minnesota and Wisconsin, including Mayo Clinic in Rochester, MN
  • MCHS’ value-based scheme tied five percent of a physician’s total compensation to the metrics focused on outcomes, safety, and patient experience during the first year:
    • 1% for outcomes measures by specialty
    • 2% for safety with e-prescriptions and medication reconciliation
    • 2% for patient experience scores
  • All performance measures improved in all regions of MCHS
  • Key elements of the implementation and management process were identified:
    • Methodical rollout of program with full leadership support
    • Robust physician performance management tools
    • Multi-faceted communication strategy
    • Data transparency and frequent reporting
    • Substantial physician support

Significance to Literature:

The first-year success of MCHS’ value-based physician compensation plan indicates significant gains in performance can be achieved even with relatively low financial risk (max 5% at stake)



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