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Value‐Based Payments in Health Care: Evidence from a Nationwide Randomized Experiment in the Home Health Sector

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  • Jun Li

Abstract

Value‐based payment programs, also known as pay‐for‐performance, use financial incentives to motivate providers to invest in quality and are a critical part of Medicare health care reform. This study examines the first year of the Home Health Value‐Based Purchasing program, a nationally representative cluster randomized experiment implemented by the Centers for Medicare & Medicaid Services in 2016. The goal of the program is to achieve better home health care quality. Home health agencies in treatment states were rewarded or penalized based on their performance on agency‐reported and non‐agency‐reported quality measures. The program improved agency‐reported measures by approximately one percentage point, and performance gains suggest a dose‐response relationship with respect to incentive size. However, the performance gains in agency‐reported measures did not reflect true quality improvement. I find evidence that agencies manipulated their coding of patients and inflated their performance. Coding manipulation explains the entirety of the program's impact on agency‐reported measures.

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  • Jun Li, 2022. "Value‐Based Payments in Health Care: Evidence from a Nationwide Randomized Experiment in the Home Health Sector," Journal of Policy Analysis and Management, John Wiley & Sons, Ltd., vol. 41(4), pages 1090-1117, September.
    • Handle: RePEc:wly:jpamgt:v:41:y:2022:i:4:p:1090-1117
    DOI: 10.1002/pam.22415
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    1. Edward C. Norton & Emily J. Lawton & Jun Li, 2023. "Moneyball in Medicare," American Journal of Health Economics, University of Chicago Press, vol. 9(1), pages 96-126.
    2. Figlio, David N., 2006. "Testing, crime and punishment," Journal of Public Economics, Elsevier, vol. 90(4-5), pages 837-851, May.
    3. Eric A. Hanushek & Margaret E. Raymond, 2005. "Does school accountability lead to improved student performance?," Journal of Policy Analysis and Management, John Wiley & Sons, Ltd., vol. 24(2), pages 297-327.
    4. Pascal Courty & Gerald Marschke, 2004. "An Empirical Investigation of Gaming Responses to Explicit Performance Incentives," Journal of Labor Economics, University of Chicago Press, vol. 22(1), pages 23-56, January.
    5. Deaton, Angus & Cartwright, Nancy, 2018. "Understanding and misunderstanding randomized controlled trials," Social Science & Medicine, Elsevier, vol. 210(C), pages 2-21.
    6. Julie Berry Cullen & Randall Reback, 2006. "Tinkering Toward Accolades: School Gaming Under a Performance Accountability System," NBER Working Papers 12286, National Bureau of Economic Research, Inc.
    7. Jeffrey R Kling & Jeffrey B Liebman & Lawrence F Katz, 2007. "Experimental Analysis of Neighborhood Effects," Econometrica, Econometric Society, vol. 75(1), pages 83-119, January.
    8. A. Colin Cameron & Douglas L. Miller, 2015. "A Practitioner’s Guide to Cluster-Robust Inference," Journal of Human Resources, University of Wisconsin Press, vol. 50(2), pages 317-372.
    9. Burt S Barnow, 2000. "Exploring the relationship between performance management and program impact: A case study of the job training partnership act," Journal of Policy Analysis and Management, John Wiley & Sons, Ltd., vol. 19(1), pages 118-141.
    10. James J. Heckman & Carolyn Heinrich & Jeffrey Smith, 2002. "The Performance of Performance Standards," Journal of Human Resources, University of Wisconsin Press, vol. 37(4), pages 778-811.
    11. Margaret E. Brehm, 2018. "The Effects of Federal Adoption Incentive Awards for Older Children on Adoptions From U.S. Foster Care," Journal of Policy Analysis and Management, John Wiley & Sons, Ltd., vol. 37(2), pages 301-330, March.
    12. Miriam Bruhn & David McKenzie, 2009. "In Pursuit of Balance: Randomization in Practice in Development Field Experiments," American Economic Journal: Applied Economics, American Economic Association, vol. 1(4), pages 200-232, October.
    13. Prashant C. Fuloria & Stefanos A. Zenios, 2001. "Outcomes-Adjusted Reimbursement in a Health-Care Delivery System," Management Science, INFORMS, vol. 47(6), pages 735-751, June.
    14. Pierre Koning & Carolyn J. Heinrich, 2013. "Cream‐Skimming, Parking and Other Intended and Unintended Effects of High‐Powered, Performance‐Based Contracts," Journal of Policy Analysis and Management, John Wiley & Sons, Ltd., vol. 32(3), pages 461-483, June.
    15. Carolyn J. Heinrich & Gerald Marschke, 2010. "Incentives and their dynamics in public sector performance management systems," Journal of Policy Analysis and Management, John Wiley & Sons, Ltd., vol. 29(1), pages 183-208.
    16. C. Kirabo Jackson & Jonah E. Rockoff & Douglas O. Staiger, 2014. "Teacher Effects and Teacher-Related Policies," Annual Review of Economics, Annual Reviews, vol. 6(1), pages 801-825, August.
    17. Young, Alwyn, 2019. "Channeling Fisher: randomization tests and the statistical insignificance of seemingly significant experimental results," LSE Research Online Documents on Economics 101401, London School of Economics and Political Science, LSE Library.
    18. David N. Figlio & Lawrence S. Getzler, 2002. "Accountability , Ability and Disability: Gaming the System," NBER Working Papers 9307, National Bureau of Economic Research, Inc.
    19. Alwyn Young, 2019. "Channeling Fisher: Randomization Tests and the Statistical Insignificance of Seemingly Significant Experimental Results," The Quarterly Journal of Economics, President and Fellows of Harvard College, vol. 134(2), pages 557-598.
    20. Kostas Selviaridis & Finn Wynstra, 2015. "Performance-based contracting: a literature review and future research directions," International Journal of Production Research, Taylor & Francis Journals, vol. 53(12), pages 3505-3540, June.
    21. Roth, Jonathan & Sant’Anna, Pedro H.C. & Bilinski, Alyssa & Poe, John, 2023. "What’s trending in difference-in-differences? A synthesis of the recent econometrics literature," Journal of Econometrics, Elsevier, vol. 235(2), pages 2218-2244.
    22. Frank A. Sloan & Hirschel Kasper (ed.), 2008. "Incentives and Choice in Health Care," MIT Press Books, The MIT Press, edition 1, volume 1, number 0262693658, December.
    23. Weisbrod, Burton A, 1991. "The Health Care Quadrilemma: An Essay on Technological Change, Insurance, Quality of Care, and Cost Containment," Journal of Economic Literature, American Economic Association, vol. 29(2), pages 523-552, June.
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