The role of disease management in pay-for-performance programs for improving the care of chronically ill patients

Jeff Beich, Dennis Patrick Scanlon, Jan Ulbrecht, Eric W. Ford, Ibrahim A. Ibrahim

Research output: Contribution to journalArticle

10 Citations (Scopus)

Abstract

To date, pay-for-performance programs targeting the care of persons with chronic conditions have primarily been directed at physicians and provide an alternative to health plan-sponsored chronic disease management (DM) programs. Both approaches require similar infrastructure, and each has its own advantages and disadvantages for program implementation. Pay-for-performance programs use incentives based on patient outcomes; however, an alternative system might incorporate measures of structure and process. Using a conceptual framework, the authors explore the variation in 50 diabetes DM programs using data from the 2002 National Business Coalition on Health's eValue8 Request for Information (RFI). The authors raise issues relevant to the assignment of accountability for patient outcomes to either health plans or physicians. They analyze the association between RFI scores measuring structures and processes, and HEDIS diabetes intermediate outcome measures. Finally, the strengths and weaknesses of using the RFI scores as an alternative metric for pay-for-performance programs are discussed.

Original languageEnglish (US)
JournalMedical Care Research and Review
Volume63
Issue number1 SUPPL.
DOIs
StatePublished - Feb 1 2006

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Incentive Reimbursement
Disease Management
Chronic Disease
Health
Physicians
Process Assessment (Health Care)
Social Responsibility
Motivation
Outcome Assessment (Health Care)

All Science Journal Classification (ASJC) codes

  • Health Policy

Cite this

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abstract = "To date, pay-for-performance programs targeting the care of persons with chronic conditions have primarily been directed at physicians and provide an alternative to health plan-sponsored chronic disease management (DM) programs. Both approaches require similar infrastructure, and each has its own advantages and disadvantages for program implementation. Pay-for-performance programs use incentives based on patient outcomes; however, an alternative system might incorporate measures of structure and process. Using a conceptual framework, the authors explore the variation in 50 diabetes DM programs using data from the 2002 National Business Coalition on Health's eValue8 Request for Information (RFI). The authors raise issues relevant to the assignment of accountability for patient outcomes to either health plans or physicians. They analyze the association between RFI scores measuring structures and processes, and HEDIS diabetes intermediate outcome measures. Finally, the strengths and weaknesses of using the RFI scores as an alternative metric for pay-for-performance programs are discussed.",
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The role of disease management in pay-for-performance programs for improving the care of chronically ill patients. / Beich, Jeff; Scanlon, Dennis Patrick; Ulbrecht, Jan; Ford, Eric W.; Ibrahim, Ibrahim A.

In: Medical Care Research and Review, Vol. 63, No. 1 SUPPL., 01.02.2006.

Research output: Contribution to journalArticle

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