A large group of California physicians given financial incentives to improve the quality of medical care have begun to embrace some changes important to advancing quality. However, many health plans are still waiting for more conclusive evidence of improvement, according to a RAND Corp. study.
Measures adopted by medical groups include speeding up the adoption of information technology such as electronic medical records, more closely tracking the improvement of physician performance and sharpening institutional focus on quality, according to findings published in the Health Affairs.
The project was supported by a grant from the California HealthCare Foundation.
Despite these advances, however, the changes had not translated into breakthrough quality improvements after 3 years of investment, according to the researchers.
“Physician groups are responding to pay-for-performance programs by making practice changes and altering how they compensate physicians to reward quality, but health plans and purchasers say that those investments are not yet translating into substantial gains in quality,” Cheryl Damberg, lead author and a senior policy researcher at RAND, said in a press release. “The true benefits of these programs may take more time to be realized, and it is likely that investments in other quality efforts will be needed in addition to performance-based pay.”
The investigators found that medical groups are providing some payments to individual physicians based on quality measures, and physicians in the program are receiving more feedback about whether they are attaining quality goals.
RAND researchers are evaluating a statewide pay-for-performance program launched by the California Integrated Healthcare Association in 2003. The initiative includes seven major California health plans and 225 physician groups. The groups employ 35,000 physicians who care for 6.2 million people enrolled in commercial health maintenance organizations and point-of-service plans.
Under the program, physician groups receive financial bonuses if they meet certain performance guidelines, such as increasing the number of patients with diabetes who receive recommended blood tests. Other performance measures include improving patient experience with getting care and adopting health information technology capabilities.
Between 2003 and 2007, the participating health plans paid $203 million in incentives to participating physician groups.
The RAND study reports findings gathered from surveys of 35 medical groups, the seven health plans and representatives from two employers that are involved in the pay-for-performance experiment.
Most of the medical groups surveyed suggested that the program’s financial incentives — generally about $1,500 to $2,000 annually per physician — were too small to stimulate significant change among most doctors. They suggested the incentives needed to be two to five times higher in order to achieve quality improvements.