CORE study links a value-based payment model with increased outpatient healthcare use

September 15, 2023

Findings also highlight the essential role of staff engagement in VBP implementation

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  • Healthcare payers are increasingly using value-based payments (VBP) to incentivize clinical performance on quality, cost, and patient outcomes.
  • A recent study by Providence CORE evaluated a primary care-focused VBP model at 130 Oregon clinics.
  • The study found increased use of primary and specialty care among patients at clinics implementing the model. It also highlights the importance of staff engagement and buy-in.

U.S. healthcare costs are among the world’s highest. Yet despite those high costs, variations in quality and outcomes persist across demographic groups and geographic areas, as well as between providers and health plans. In response, health insurers and other healthcare payers are exploring the impacts of value-based payments (VBPs), which financially incentivize cost-effective and high-quality care, rather than the traditional approach of paying providers for the volume of services provided. There is growing excitement for VBPs in primary care specifically because of their potential to support critical primary care tasks such as care coordination and self-management that are not funded under traditional volume-based models.

A new study from our team at the Providence Center for Outcomes Research and Education (CORE) adds to the evidence around this promising approach by exploring the implementation of a primary care-focused VBP model across approximately 130 clinics in Oregon. The study, funded by The Patrick & Catherine Weldon Donaghue Medical Research Foundation, linked the model, known as the primary care payment model (PCPM), to significant increases in primary and specialty care use among patients at participating clinics. Findings also highlighted the vital role of staff buy-in and involvement in successful VBP implementations.

About the study: A mixed methods approach

The first iteration of the PCPM model was implemented in 2015 by CareOregon, a payer with both Medicaid and Medicare Advantage plans; it has since been updated annually based on feedback from participating clinics. For quantitative data, we used Oregon’s All Payer All Claims database to compare the change in healthcare encounters from 2016 to 2019 between 68,807 patients seen at a PCPM clinic, compared to a control group of 71,695 individuals that received all their care at a non-PCPM clinic.

In 2022, we interviewed clinic staff at seven health centers in three regions in Oregon. We also administered an online discussion group among clinical care team staff. Interviews focused on staff motivation to participate in the PCPM and their experiences with it.

Key finding #1: Utilization of primary and specialty care increased among patients at the PCPM clinics

Increasing patient use of primary and preventative care is often cited as a goal of VBP programs; this study showed that patients at the PCPM clinics experienced a greater connection to primary and specialty care – both in terms of the proportion who used care and the average amount of care used per member – relative to the control group. The proportion of patients who used primary care increased by 9.2 percent above what would have been expected given the increase for controls. For specialty care, the increase was 6.2 percent above what would have been expected given the increase for controls.

Notably, we also found that individuals served at the PCPM clinics who were not members of the health plan also experienced an improved connection to primary care. This evidence suggests a spillover effect likely driven by the implementation of the VBP model at those clinics.

Not only did we see evidence that this VBP model led to better connections to healthcare for its intended patient population, but it also had an unintended positive impact on other patients. This spillover effect suggests that there may be opportunities for alignment and partnership across health plans around funding for similar VBP models,” Hannah Cohen-Cline, PhD, MPH Program Director, Research & Evaluation, CORE

Key finding #2: Clinical staff engagement is essential to VBP implementation

Staff buy-in is widely considered vital to process improvement efforts. This study strongly supports that idea when it comes to implementing VBP models in clinical settings. We found that the PCPM was most successfully implemented when the clinic had buy-in from care team staff. It also illustrates a key concept in gaining that buy-in; time and time again, care staff emphasized that the best way to get staff buy-in is to show how the process improvement directly benefits patients. Furthermore, clinics that were most successful at cultivating buy-in also included care providers and frontline staff in creating, designing, and testing those workflows.

“I think the heart is improving patient care, but the drive is improving process where (staff are) really tuned into how can we make this process better.” - Clinic interviewee.

“I don't think it has anything to do with making a few more bucks. It has to do with just being able to provide the best care and get these people where they need to be to get that care.” - Clinic interviewee.

Next steps and conclusions

While the health plan considered this PCPM implementation a first step to help clinics prepare for more advanced models anticipated in the future, the study found a clinically meaningful and statistically significant increase in the use of primary and specialty care across clinics utilizing the model. Findings also highlight the vital need for patient-centered communication to staff and staff involvement in VBP implementations. 

“We see PCPM as being a feeder to move clinics to the next level, which would be to have a share for risk payments” - Health plan interviewee.

Going forward, the CORE team looks forward to building on these findings through continued work with the study funder, The Patrick and Catherine Weldon Donaghue Medical Research Foundation, and additional work with our partners at CareOregon on their Strategic Healthcare Investment for Transformation (SHIFT) program for behavioral health agencies in Oregon.

Related resources

●      Blog post: Evaluating VBP in primary care

●      Learn more about VBPs and Medicaid at Medicaid.org

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