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Quality improvement with pay-for-performance incentives in integrated behavioral health care

Author

Listed:
  • Unützer, J.
  • Chan, Y.-F.
  • Hafer, E.
  • Knaster, J.
  • Shields, A.
  • Powers, D.
  • Veith, R.C.

Abstract

Objectives: We evaluated a quality improvement program with a pay-for-performance (P4P) incentive in a population-focused, integrated care program for safety-net patients in 29 community health clinics. Methods: We used a quasi-experimental design with 1673 depressed adults before and 6304 adults after the implementation of the P4P program. Survival analyses examined the time to improvement in depression before and after implementation of the P4P program, with adjustments for patient characteristics and clustering by health care organization. Results: Program participants had high levels of depression, other psychiatric and substance abuse problems, and social adversity. After implementation of the P4P incentive program, participants were more likely to experience timely follow-up, and the time to depression improvement was significantly reduced. The hazard ratio for achieving treatment response was 1.73 (95% confidence interval = 1.39, 2.14) after the P4P program implementation compared with preprogram implementation. Conclusions: Although this quasi-experiment cannot prove that the P4P initiative directly caused improved patient outcomes, our analyses strongly suggest that when key quality indicators are tracked and a substantial portion of payment is tied to such quality indicators, the effectiveness of care for safety-net populations can be substantially improved.

Suggested Citation

  • Unützer, J. & Chan, Y.-F. & Hafer, E. & Knaster, J. & Shields, A. & Powers, D. & Veith, R.C., 2012. "Quality improvement with pay-for-performance incentives in integrated behavioral health care," American Journal of Public Health, American Public Health Association, vol. 102(6), pages 41-45.
    • Handle: RePEc:aph:ajpbhl:10.2105/ajph.2011.300555_7
    DOI: 10.2105/AJPH.2011.300555
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    Cited by:

    1. Arimoto, Yutaka & 有本, 寛 & Kurata, Masamitsu, 2017. "Adoption of Management Practices in the Public Sector of Bangladesh," Discussion Paper Series 654, Institute of Economic Research, Hitotsubashi University.
    2. Stokes, Jonathan & Struckmann, Verena & Kristensen, Søren Rud & Fuchs, Sabine & van Ginneken, Ewout & Tsiachristas, Apostolos & Rutten van Mölken, Maureen & Sutton, Matt, 2018. "Towards incentivising integration: A typology of payments for integrated care," Health Policy, Elsevier, vol. 122(9), pages 963-969.
    3. Asadi-Aliabadi, Mehran & Karimi, Seyed M & Tehrani-Banihashemi, Arash & Mirbaha-Hashemi, Fariba & Janani, Leila & Babaee, Ebrahim & Nojomi, Marzieh & Moradi-Lakeh, Maziar, 2022. "Effectiveness of pay for performance to non-physician health care providers: A systematic review," Health Policy, Elsevier, vol. 126(7), pages 592-602.
    4. Tobias Romeyke & Elisabeth Noehammer & Harald Stummer, 2022. "Incentives for Combining Structure and Process Quality to Improve Outcome in Rheumatic Treatment," SAGE Open, , vol. 12(3), pages 21582440221, September.

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