Table 3.
Effects of Five Identified VBP Initiatives That Have Been Formally Evaluated.
| Name initiative | References | Study design | Effects on resource use/spending | Effects on quality |
|---|---|---|---|---|
| 4. Alternative Quality Contract (AQC) | 1. Afendulis et al. (2014) | 1. DiD analyses of drug spending and utilization between 2006 and 2010. | 1. No significant effect on drugs utilization. | |
| 2. Barry et al. (2015) | 2. DiD analyses of probability of mental health service use, spending, HEDIS metrics for diabetes and cardiovascular conditions using 2006-2011 data. | 2. Intervention group is slightly less likely (−1.41%; p < .05) to use mental health services. No significant change in mental health spending, but a 1% annual decline in total health care spending for mental health services users. | 2. No significant improvements for diabetes or cardiovascular disease among enrollees with co-occurring mental health care use. For two measures (nephropathy monitoring and retinal exams) nonmental health users appear to have benefited more than mental health care users (annual change in probability of −2.90%; p < .01, and −2.57%; p < .05). | |
| 3. Chien et al. (2014) | 3. DiD analyses of quality and spending between 2006 and 2010 for children aged 0 to 21 years, including children with special health care needs (CSHCN). | 3. No significant effect on spending trends. | 3. Significant, positive effect on pediatric preventive care quality measures tied to P4P (+1.8% for CSHCN and +1.2% for non-CSHCN; p < .001). No significant changes for measures not tied to P4P. | |
| 4. Huskamp et al. (2016) | 4. DiD analyses of tobacco cessation service use using 2006-2011 data. | 4. Significant increases rates of tobacco cessation treatment use for the overall population (+0.13%; p < .0001). | ||
| 5. McWilliam, Landon, and Chernew (2013) | 5. DiD analyses of spending and quality between 2007 and 2010 for elderly FFS Medicare beneficiaries in Massachusetts served by 11 provider organizations entering the AQC in 2009 or 2010 versus beneficiaries served by other providers. | 5. Significant reductions in spending for Medicare beneficiaries in intervention (change of −$99 or −3.4% relative to an expected quarterly mean of $2.895; p = .02). | 5. Significant improvements of some measures (e.g., 3.1% for low-density lipoprotein cholesterol testing [p < .001] and 2.5% for cardiovascular disease [p < .001]), but no differential change for others. | |
| 6. Sharp et al. (2013) | 6. DiD analyses of emergency department (ED) visits using 2006-2009 data. | 6. No significant effect on ED use. | ||
| 7. Song et al. (2011) | 7. DiD analyses of spending and quality using 2006-2009 data. | 7. Smaller spending increase for intervention group, that is, $15.51 less per quarter (−1.9%; p = .007). | 7. Improved quality for chronic conditions in adults (p < .001) and pediatric care (p = .001) after 1 year, but not for adult preventive care. | |
| 8. Song et al. (2012) | 8. DiD analyses of spending using 2006-2010 data for the 2009 and 2010 intervention cohort. | 8. Savings of $22.58 over 2 years (−2.8%; p = .04). | 8. Improvements in measures for chronic care management (+3.7%; p < .001), adult preventive care (+0.3%; p = .008), and pediatric care (+0.3%; p < .001). | |
| 9. Song et al. (2013) | 9. DiD analyses of spending and utilization of several categories of medical technologies and quality using 2006-2010 data | 9. Higher use of colonoscopies for the intervention group in the first 2 years of the contract (+5.2%;p = .04). Decreases in spending on cardiovascular services in the first 2 years (−7.4%; p = .02), and on imaging services (−6.1%; p < .001). No effect in orthopedics | ||
| 10. Song et al. (2014) | 10. DiD analyses of spending and unadjusted DiD analyses for ambulatory process quality and outcome measures during the first 4 years (2009-2012) of the initiative for the 2009, 2010, 2011, and 2012 cohorts using 2006-2012 data | 10. Over the 4-year period lower spending growth for the intervention group (6.8% for the 2009 cohort; p < .001). The 2010/2011/2012 cohorts had savings of 8.8% (p < .001), 9.1% (p < .001), and 5.8% (p = .04) | 10. Measures of chronic disease management increased by 3.9%, and unadjusted performance in adult preventive care and pediatric care increased by 2.7% and 2.4% (p values are unavailable) compared to the HEDIS national average. The five outcome measures for patients with diabetes, patients with coronary artery disease, and patients with hypertension improved compared to the national and regional HEDIS scores (size of the effect and p values unavailable). | |
| 11. Song et al. (2017) | 11. DiD analyses of spending and quality using 2006-2012 data for enrollees in areas with lower and higher socioeconomic status. Outcome measures were measured only after the intervention | 11. No significant differences in spending between areas with lower versus higher socioeconomic status | 11. Process measures improved +1.2% per year more among individuals living in areas with lower versus higher socioeconomic status (p < .001). No significant differences in outcome measures. | |
| 12. Stuart et al. (2017) | 12. DiD analyses of substance use disorder service use, spending, and three HEDIS-based performance measures related to substance use disorder using 2006-2011 data | 12. No sizeable changes | 12. No sizeable changes. | |
| 10. Gesundes Kinzigtal | 1. Pimperl et al. (2017) | 1. Quasi-experimental design using propensity score matched control to evaluate the effect on population health using 2005-2013 data. Control group is a random sample of all members of the two insurers in the region Baden-Wurttemberg of 18 years and older. | Not available | 1. For the ACO intervention group age at time of death is on average 1.4 years higher compared to the control group but not significant, 639 fewer years of potential life were lost compared to the control group (p < .05), and the estimated survival time is approximately 7 days higher for beneficiaries participating in the program (significant; p value unavailable). |
| 14. Medicare Shared Savings Program | 1. Borza et al. (2019) | 1. DiD analyses of hospital readmission after common surgical procedures using 2010-2014 data. | 1. Significant reduction in readmissions for hospitals in the program (−0.52%; p = .021). | |
| 2. Busch, Huskamp, and McWilliams (2016) | 2. DiD analyses of mental health care spending, utilization, and quality using 2008-2013 data. | 2. No significant changes in mental health care spending and utilization. | 2. No significant changes in quality metrics. | |
| 3. Colla et al. (2016) | 3. DiD analyses of spending and high-cost institutional use using 2009-2013 data. | 3. Modest reductions in total spending (−1.3%; p < .001). Hospital and ED use reduced significantly by 1.3 (p < .05) and 3.0 (p < .01) events per 1,000 beneficiaries per quarter. | ||
| 4. Herrel et al. (2016) | 4. DiD analyses of 30-day mortality, complications, readmissions, and length of stay for patients undergoing a major surgical resection for various types of cancer using 2011-2013 data. | 4. No significant effect on perioperative outcome measures. | ||
| 5. McWilliam, Landon, Chernew, and Zaslavsky (2014) | 5. DiD analyses of patient experience using 2010-2013 data. | 5. Improvements in some patients experience measures (e.g., effect size for reports of timely access to care is 2.1 standard deviation of the ACO-level distribution, adjusted for trends; p = .02), but not (significantly) in others (e.g., overall ratings of care and physicians). | ||
| 6. McWilliam, Hatfield, Chernew, Landon, and Schwartz (2016) | 6. DiD analyses of spending and quality using 2009-2013 data. | 6. Significant reductions in spending for the 2012 cohort (−1.4%; p = .02), but not for the 2013 cohort. | 6. No significant differences in quality or use of low-value services for the majority of measures. | |
| 7. McWilliams et al. (2017) | 7. DiD analyses of post-acute spending and utilization using 2009-2014 data. | 7. Significant reductions in post-acute spending (−9.0%; p = .003 for 2012 ACO cohort and smaller for the 2013 and 2014 cohort). | ||
| 8. Winblad et al. (2017) | 8. DiD analyses of all-cause rehospitalizations from skilled nursing facilities using 2007-2013 data. | 8. Significant reduction in rehospitalization rate (−0.994%;p < .01). | ||
| 16. Partners for Kids Program | 1. Gleeson et al. (2016) | 1. DiD analyses of pediatric performance of primary care physicians using 2010-2013 data. | 1. Significant improvements in 8 of the 14 HEDIS measures for preventive care, chronic care, and acute care primary care services for the group of Nationwide Children Hospital physicians compared to incentivized physicians (“traditional” P4P). ORs favored the intervention group mainly in the immunization measures (range of OR of 0.34 with CI of [0.31, 0.37] for hepatitis vaccine to 0.86 with CI of [0.78, 0.95] for meningococcal vaccine). | |
| 2. Kelleher et al. (2015) | 2. Observational study of spending, growth rates, and quality using 2008-2013 data. Results for the PFK group is compared to Ohio Medicaid FFS and Ohio managed care (MC). | 2. Compared to both control groups, PMPM spending was significantly lower in 2008, and grew at a rate of $2.40 per year compared to $16.15 per year in the FFS group (p < .001) and $6.47 per year (p < .121) in the MC group. | 2. Significant improvement for gastroenteritis admission rate (−0.05 events/1,000; p = .000), pediatric quality acute composite (−0.03 events/1,000; p = .018), and pediatric quality overall composite (−0.05 events/1,000; p = .046). Significant declines in quality regarding diabetes short-term admission rates (+0.02 events/1,000; p = .027) and perioperative hemorrhage or hematoma rates (+3.99 events/1,000; p = .048). No significant differences on 10 other measures. | |
| 17. ProvenHealth Navigator | 1. Gilfillan et al. (2010) | 1. DiD analyses of hospital admissions, readmission rates, and the total cost of care using 2005-2008 data for Medicare Advantage patients at 11 intervention sites and 75 control groups | 1. Significant reduction in hospital admissions (−18%; p < .01) and readmissions (−36%; p = .02). Total cost of care decreased 7% (not significant) | Not available |
Note. VBP = value-based payment; DID = difference-in-differences; ACO = accountable care organization; PFK = Partners for Kids; FFS = fee-for-service; HEDIS = healthcare effectiveness data and information set; OR = odds ratio; CI = confidence interval.