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The business case for pediatric asthma quality improvement in low-income populations: examining a provider-based pay-for-reporting intervention.
Int J Qual Health Care. 2015 Jun; 27(3):189-95.IJ

Abstract

OBJECTIVE

To measure the return on investment (ROI) for a pediatric asthma pay-for-reporting intervention initiated by a Medicaid managed care plan in New York State.

DESIGN

Practice-level, randomized prospective evaluation.

SETTING

Twenty-five primary care practices providing care to children enrolled in the Monroe Plan for Medical Care (the Monroe Plan).

PARTICIPANTS

Practices were randomized to either treatment (13 practices, 11 participated) or control (12 practices).

INTERVENTION

For each of its eligible members assigned to a treatment group practice, the Monroe plan paid a low monthly incentive fee to the practice. To receive the incentive, treatment group practices were required to conduct, and report to the Monroe Plan, the results of chart audits on eligible members. Chart audits were conducted by practices every 6 months. After each chart audit, the Monroe Plan provided performance feedback to each practice comparing its adherence to asthma care guidelines with averages from all other treatment group practices. Control practices continued with usual care.

MAIN OUTCOME MEASURES

Intervention implementation and operating costs and per member, per month claims costs. ROI was measured by net present value (discounted cash flow analysis).

RESULTS

The ROI to the Monroe Plan was negative, primarily due to high intervention costs and lack of reductions in spending on emergency department and hospital utilization for children in treatment relative to control practices.

CONCLUSIONS

A pay-for-reporting, chart audit intervention is unlikely to achieve the meaningful reductions in utilization of high-cost services that would be necessary to produce a financial ROI in 2.5 years.

Authors+Show Affiliations

Department of Health Policy and Management, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, NC 27599-7411, USA.Mathematica Policy Research, Inc., Washington, DC 20002-4221, USA.Cecil G. Sheps Center for Health Services Research, The University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA.Deputy Director of the Center on Health Care Effectiveness, Mathematica Policy Research, Inc., Princeton, NJ 08543, USA.Department of Health Policy and Management, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, NC 27599-7411, USA Cecil G. Sheps Center for Health Services Research, The University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA.

Pub Type(s)

Journal Article
Randomized Controlled Trial
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

25855751

Citation

Reiter, Kristin L., et al. "The Business Case for Pediatric Asthma Quality Improvement in Low-income Populations: Examining a Provider-based Pay-for-reporting Intervention." International Journal for Quality in Health Care : Journal of the International Society for Quality in Health Care, vol. 27, no. 3, 2015, pp. 189-95.
Reiter KL, Lemos KA, Williams CE, et al. The business case for pediatric asthma quality improvement in low-income populations: examining a provider-based pay-for-reporting intervention. Int J Qual Health Care. 2015;27(3):189-95.
Reiter, K. L., Lemos, K. A., Williams, C. E., Esposito, D., & Greene, S. B. (2015). The business case for pediatric asthma quality improvement in low-income populations: examining a provider-based pay-for-reporting intervention. International Journal for Quality in Health Care : Journal of the International Society for Quality in Health Care, 27(3), 189-95. https://doi.org/10.1093/intqhc/mzv018
Reiter KL, et al. The Business Case for Pediatric Asthma Quality Improvement in Low-income Populations: Examining a Provider-based Pay-for-reporting Intervention. Int J Qual Health Care. 2015;27(3):189-95. PubMed PMID: 25855751.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - The business case for pediatric asthma quality improvement in low-income populations: examining a provider-based pay-for-reporting intervention. AU - Reiter,Kristin L, AU - Lemos,Kristin Andrews, AU - Williams,Charlotte E, AU - Esposito,Dominick, AU - Greene,Sandra B, Y1 - 2015/04/07/ PY - 2015/03/07/accepted PY - 2015/4/10/entrez PY - 2015/4/10/pubmed PY - 2016/3/5/medline KW - Medicaid KW - asthma KW - audit and feedback KW - business case KW - pay-for-reporting KW - return on investment SP - 189 EP - 95 JF - International journal for quality in health care : journal of the International Society for Quality in Health Care JO - Int J Qual Health Care VL - 27 IS - 3 N2 - OBJECTIVE: To measure the return on investment (ROI) for a pediatric asthma pay-for-reporting intervention initiated by a Medicaid managed care plan in New York State. DESIGN: Practice-level, randomized prospective evaluation. SETTING: Twenty-five primary care practices providing care to children enrolled in the Monroe Plan for Medical Care (the Monroe Plan). PARTICIPANTS: Practices were randomized to either treatment (13 practices, 11 participated) or control (12 practices). INTERVENTION: For each of its eligible members assigned to a treatment group practice, the Monroe plan paid a low monthly incentive fee to the practice. To receive the incentive, treatment group practices were required to conduct, and report to the Monroe Plan, the results of chart audits on eligible members. Chart audits were conducted by practices every 6 months. After each chart audit, the Monroe Plan provided performance feedback to each practice comparing its adherence to asthma care guidelines with averages from all other treatment group practices. Control practices continued with usual care. MAIN OUTCOME MEASURES: Intervention implementation and operating costs and per member, per month claims costs. ROI was measured by net present value (discounted cash flow analysis). RESULTS: The ROI to the Monroe Plan was negative, primarily due to high intervention costs and lack of reductions in spending on emergency department and hospital utilization for children in treatment relative to control practices. CONCLUSIONS: A pay-for-reporting, chart audit intervention is unlikely to achieve the meaningful reductions in utilization of high-cost services that would be necessary to produce a financial ROI in 2.5 years. SN - 1464-3677 UR - https://www.unboundmedicine.com/medline/citation/25855751/The_business_case_for_pediatric_asthma_quality_improvement_in_low_income_populations:_examining_a_provider_based_pay_for_reporting_intervention_ L2 - https://academic.oup.com/intqhc/article-lookup/doi/10.1093/intqhc/mzv018 DB - PRIME DP - Unbound Medicine ER -