USING FINANCIAL INCENTIVES TO
INFLUENCE CLINICAL DECISION MAKING
S O R AYA G H E B L E H , M P H
T H E D A R T M O U T H I...
PROVIDER DECISION MAKING
-  Providers are a major component influencing healthcare
outcomes and healthcare expenditures
- ...
HEALTHCARE REFORM
-  Healthcare reform aims to realign financial incentives with quality of care
-  The Institute of Medic...
WHAT ARE THE ISSUES?
(1)  Fee-for-service drives high healthcare costs because providers are incentivized to
perform more ...
WHY ARE FINANCIAL INCENTIVES IMPORTANT?
-  Providers are the target population for financial incentive
models in healthcar...
KEY DETERMINANTS
Biology Behaviors
Social
Environment
Physical
Environment
Policies and
Interventions
Access to
Quality
He...
KEY DETERMINANT - BIOLOGY
Biological makeup of providers varies widely and can directly affect how they
respond to financi...
KEY DETERMINANT - BEHAVIORS
Provider behaviors implicated in decision-making include:
• Prescribing habits
• Personal work...
KEY DETERMINANT – SOCIAL ENVIRONMENT
Different Provider Settings
• Hospitals
• Clinics
• Ambulatory Care Centers
• Offices...
KEY DETERMINANT – PHYSICAL ENVIRONMENT
-  Provider access to necessary tools for quality
improvement is crucial
-  Provide...
KEY DETERMINANT – POLICES & INTERVENTIONS
Structure of the incentive affects provider participation
Government policy fact...
KEY DETERMINANT – ACCESS TO QUALITY HEALTH CARE
Lack of reimbursement to providers and healthcare settings that
see patien...
WHAT NOW?
Financial incentives should be used in defined settings for defined problems
within defined populations where me...
LARGE AND SMALL PROVIDER SETTINGS
Large Provider Settings
Can assume more
risk
Higher capabilities
for infrastructure and
...
CHARACTERISTICS TO CONSIDER
-  Interventions of any kind should be explicitly described and known to
providers so they are...
CONCLUSIONS
Financial incentives are not going anywhere and will
continue to be implemented in a variety of healthcare
set...
Upcoming SlideShare
Loading in …5
×

Soraya Ghebleh - Using Financial Incentives to Influence Clinical Decision Making

394 views
247 views

Published on

This slide deck discusses some of the relevant factors that should be considered when designing financial incentives for providers of healthcare services.

Published in: Health & Medicine, Business
0 Comments
2 Likes
Statistics
Notes
  • Be the first to comment

No Downloads
Views
Total views
394
On SlideShare
0
From Embeds
0
Number of Embeds
1
Actions
Shares
0
Downloads
2
Comments
0
Likes
2
Embeds 0
No embeds

No notes for slide

Soraya Ghebleh - Using Financial Incentives to Influence Clinical Decision Making

  1. 1. USING FINANCIAL INCENTIVES TO INFLUENCE CLINICAL DECISION MAKING S O R AYA G H E B L E H , M P H T H E D A R T M O U T H I N S T I T U T E F O R H E A LT H P O L I C Y A N D C L I N I C A L P R A C T I C E
  2. 2. PROVIDER DECISION MAKING -  Providers are a major component influencing healthcare outcomes and healthcare expenditures -  The most expensive item in healthcare is the “provider’s pen” -  Resource utilization is determined by provider decision making -  Under the existing Fee-for-service (FFS) in healthcare:
  3. 3. HEALTHCARE REFORM -  Healthcare reform aims to realign financial incentives with quality of care -  The Institute of Medicine’s six aims for improving quality in healthcare include -  Safety, Effective, Patient-Centered, Timely, Efficient, Equitable Requires financial incentives to be tied to quality metrics in order for providers to receive reimbursement for care Incentives, however, need to be monitored and evaluated as prior attempts of using financial incentives to influence clinical decision making have not always been successful in improving quality for patients
  4. 4. WHAT ARE THE ISSUES? (1)  Fee-for-service drives high healthcare costs because providers are incentivized to perform more services without necessarily improving quality of care (2)  Magnitude of financial incentives that can potentially be introduced makes determining the appropriate incentive difficult (3)  Replication of successful results across the numerous settings available for healthcare service delivery is not assured (4)  Applicability of incentives that may work in a large provider system may not translate to a solo or small group practice (5)  Protecting practices that cannot transition towards integrated delivery that requires high-start up capital and advanced healthcare technology (6)  Numerous stakeholders need to collaborate for successful incentive programs that include providers, insurance companies, beneficiaries, and government agencies
  5. 5. WHY ARE FINANCIAL INCENTIVES IMPORTANT? -  Providers are the target population for financial incentive models in healthcare -  Potential implications with regard to ethnicity, geographical location, and cultural background of participating providers -  Distinctions between providers that work in self-owned practices and small group practices compared to those in large provider networks or accountable care organizations
  6. 6. KEY DETERMINANTS Biology Behaviors Social Environment Physical Environment Policies and Interventions Access to Quality Health care Many key factors determine which, if any, incentives should be utilized in improving the quality of care being delivered by providers
  7. 7. KEY DETERMINANT - BIOLOGY Biological makeup of providers varies widely and can directly affect how they respond to financial incentives to deliver care Specific indicators include: • Age of the physician • Where the physician went to school and trained • Gender • Religious Background and Upbringing • Value System • Ethnic Background • Socioeconomic Status • Personal Bias
  8. 8. KEY DETERMINANT - BEHAVIORS Provider behaviors implicated in decision-making include: • Prescribing habits • Personal work ethic and the amount of preparation time • Average number of tests physician typically orders • Physician self-monitoring • Personal spending habits • Size of the workload the physician takes on The target income level of the provider will affect whether a financial incentive will be an important factor, tying into family financial obligations Implicit assumption in medicine that all providers practice in the best interest of their patients
  9. 9. KEY DETERMINANT – SOCIAL ENVIRONMENT Different Provider Settings • Hospitals • Clinics • Ambulatory Care Centers • Offices • Nursing Homes • Skilled Nursing Facilities • Community Health Centers -  Provider settings dictate the structure and magnitude of incentive given to the provider -  Organizational structure and culture of the provider setting can affect the success of incentives -  The proportion of the group to which the incentive is applied is relevant
  10. 10. KEY DETERMINANT – PHYSICAL ENVIRONMENT -  Provider access to necessary tools for quality improvement is crucial -  Providers practicing in rural or impoverished areas may have different responses to incentives compared to providers practicing in urban or higher income locations -  Different geographic locations are tied with different patient populations who have different diseases and can determine the way providers react when providing care
  11. 11. KEY DETERMINANT – POLICES & INTERVENTIONS Structure of the incentive affects provider participation Government policy factors include government insurance reimbursements from Medicare and Medicaid Provider adherence to clinical guidelines set by academic institutions and what the status quo of quality provision is among a provider community are indicators of the likelihood of incentives working within that provider community Healthcare reform will have huge implications for providers if methods of reimbursement change and shared savings and accountable care models begin to dominate the healthcare arena
  12. 12. KEY DETERMINANT – ACCESS TO QUALITY HEALTH CARE Lack of reimbursement to providers and healthcare settings that see patients who are underinsured or have no insurance often leads to an increase in over-testing, over-prescribing, and over- diagnosing of patients who have more reliable insurance or the ability to pay. Providers don’t necessarily need incentives to provide increased access to quality care but under current reimbursement schemes, providers have more of an incentive to increase quantity and this has increased the cost burden.
  13. 13. WHAT NOW? Financial incentives should be used in defined settings for defined problems within defined populations where measurable results can be produced indicating a movement towards a desired improvement in quality.
  14. 14. LARGE AND SMALL PROVIDER SETTINGS Large Provider Settings Can assume more risk Higher capabilities for infrastructure and technology implementation Larger pool to measure performance improvement and quality metrics Provider buy-in and active participation is more likely in a larger setting Potential to participate in shared savings models and accountable care Large and Small Provider Settings Absolute threshold, directly measurable incentives Vaccinations Reduced repeat unnecessary lab tests Increased screenings and preventative care initiatives
  15. 15. CHARACTERISTICS TO CONSIDER -  Interventions of any kind should be explicitly described and known to providers so they are aware of what entity is paying for the intervention -  Determining short-term goals compared to long-term goals is important when coming up with metrics of success for the incentive -  Metrics to be considered for any incentive program should include the provider population providing the data, percentage of patients being targeted for the incentive, expected overall effects of the incentive, and the type of feedback given -  Financial risks and penalties can be used to influence and change physician behavior as well -  Organizational pressure can either increase or decrease intrinsic motivation to perform depending on the environment, setting, and culture
  16. 16. CONCLUSIONS Financial incentives are not going anywhere and will continue to be implemented in a variety of healthcare settings. In order for these incentives to be utilized properly, the healthcare community needs to understand that financial incentives and reimbursement strategies are provider and setting specific and they must implement incentives accordingly.

×