Dori A Cross1, Paige Nong2, Christy Harris-Lemak3, Genna R Cohen4, Ariel Linden5, Julia Adler-Milstein6. 1. University of Minnesota School of Public Health, Division of Health Policy and Management, Minneapolis, MN, USA. Electronic address: dcross@umn.edu. 2. University of Michigan School of Medicine, Department of Learning Health Sciences, Ann Arbor, MI 48109, USA. 3. University of Alabama at Birmingham, School of Health Professions, Birmingham, AL, USA. 4. Mathematica Policy Research, Washington, DC, USA. 5. Linden Consulting Group, San Francisco, CA, USA. 6. University of California San Francisco, Department of Medicine, San Francisco, CA, USA.
Abstract
BACKGROUND: Improving primary care for patients with chronic illness is critical to advancing healthcare quality and value. Yet, little is known about what strategies are successful in helping primary care practices deliver high-quality care for this population under value-based payment models. METHODS: Double-blind interviews in 14 primary care practices in the state of Michigan, stratified based on whether they did (n = 7) or did not (n = 7) demonstrate improvement in primary care outcomes for patients with at least one reported chronic disease between 2010 and 2013. All practices participate in a statewide pay-for-performance program run by a large commercial payer. Using an implementation science framework to identify leverage points for effecting organizational change, we sought to identify, describe and compare strategies among improving and non-improving practices across three domains: (1) organizational learning opportunities, (2) approaches to motivating staff, and (3) acquisition and use of resources. RESULTS: We identified 10 strategies; 6 were "differentiating" - that is, more prevalent among improving practices. These differentiating strategies included: (1) participation in learning collaboratives, (2) accessing payer tools to monitor quality performance, (3) framing pay-for-performance as a practice transformation opportunity, (4) reinvesting earned incentive money in equitable, practice-centric improvement, (5) employing a care manager, and (6) using available technical support from local hospitals and provider organizations to support performance improvement. Implementation of these strategies varied based on organizational context and relative strengths. CONCLUSIONS: Practices that succeeded in improving care for chronic disease patients pursued a mix of strategies that helped meet immediate care delivery needs while also creating new adaptive structures and processes to better respond to changing pressures and demands. These findings help inform payers and primary care practices seeking evidence-based strategies to foster a stronger delivery system for patients with significant healthcare needs.
BACKGROUND: Improving primary care for patients with chronic illness is critical to advancing healthcare quality and value. Yet, little is known about what strategies are successful in helping primary care practices deliver high-quality care for this population under value-based payment models. METHODS: Double-blind interviews in 14 primary care practices in the state of Michigan, stratified based on whether they did (n = 7) or did not (n = 7) demonstrate improvement in primary care outcomes for patients with at least one reported chronic disease between 2010 and 2013. All practices participate in a statewide pay-for-performance program run by a large commercial payer. Using an implementation science framework to identify leverage points for effecting organizational change, we sought to identify, describe and compare strategies among improving and non-improving practices across three domains: (1) organizational learning opportunities, (2) approaches to motivating staff, and (3) acquisition and use of resources. RESULTS: We identified 10 strategies; 6 were "differentiating" - that is, more prevalent among improving practices. These differentiating strategies included: (1) participation in learning collaboratives, (2) accessing payer tools to monitor quality performance, (3) framing pay-for-performance as a practice transformation opportunity, (4) reinvesting earned incentive money in equitable, practice-centric improvement, (5) employing a care manager, and (6) using available technical support from local hospitals and provider organizations to support performance improvement. Implementation of these strategies varied based on organizational context and relative strengths. CONCLUSIONS: Practices that succeeded in improving care for chronic diseasepatients pursued a mix of strategies that helped meet immediate care delivery needs while also creating new adaptive structures and processes to better respond to changing pressures and demands. These findings help inform payers and primary care practices seeking evidence-based strategies to foster a stronger delivery system for patients with significant healthcare needs.
Authors: Dori A Cross; Maria A Stevens; Steven B Spivack; Genevra F Murray; Hector P Rodriguez; Valerie A Lewis Journal: Med Care Date: 2022-02-01 Impact factor: 2.983
Authors: Nate C Apathy; Joshua R Vest; Julia Adler-Milstein; Justin Blackburn; Brian E Dixon; Christopher A Harle Journal: J Am Med Inform Assoc Date: 2021-07-14 Impact factor: 4.497
Authors: Rutger Friso IJntema; Di-Janne Barten; Hans B Duits; Brian V Tjemkes; Cindy Veenhof Journal: Qual Manag Health Care Date: 2021 Jan/Mar 01 Impact factor: 1.147