Behavioral Economics in Provider Incentive Design

NCT02634879 | Completed

• 1 other identifier: 823358
• Study Type: interventional
• Target: 83
• Locations: 0 countries
• Sites: N/A

Brief Summary

The shift towards value-based reimbursement in U.S. healthcare is accelerating. Payment reform initiatives have taken many shapes-accountable care organizations, bundled payments, value-based purchasing, medical homes, global payment-but all share the common strategy of tying provider (physician, hospital, health system) reimbursement to performance on costs, outcomes, or both. Yet, pay-for-performance has demonstrated little effect on physician behavior and patient outcomes. Payers and provider groups are in need of novel approaches to structure provider incentives-both financial and non-financial-to better promote the delivery of quality, cost-effective care. In this project, the study team plans to study how behavioral economic principles can improve the effectiveness of physician incentives to deliver higher quality and lower cost care. They will test the application of specific behavioral economic principles including immediacy, social pressure, and loss aversion in incentive design and implementation. The study will contribute to an empirical foundation for re-design of existing physician incentive programs and implementation of new policies through secondary data analyses and a multi-arm experiment that evaluate the impact of promising behavioral economics principles on the effectiveness of provider financial and nonfinancial incentives.

Conditions

Diabetes

Outcome Measures

Primary Outcomes (1)

• Physician performance

  Measured by physician-level CI composite quality measure score

  Baseline to 12 months

Secondary Outcomes (3)

• Physician Practice Behavior

  Baseline to 12 months

• Physician Incentive Payouts

  Throughout the 12 months

• Patient satisfaction

  6 months to 12 months

Study Arms (3)

Control

NO INTERVENTION

Control Group

Loss Aversion

ACTIVE COMPARATOR

Each physician in this arm will have access to funds prior to earning them.

Behavioral: Incentive Change

Group Incentive

ACTIVE COMPARATOR

Each physician will receive 50% of their potential incentive based on group performance. Physicians will also receive information on the performance of physicians on key CI measures in their group.

Behavioral: Incentive Change

Interventions

Incentive Change BEHAVIORAL

Group Incentive; Loss Aversion

Eligibility Criteria

• Age: 18 Years+
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64), Older Adult (65+)

You may qualify if:

• Physician at participating provider organization (PCP and specific specialties)

You may not qualify if:

• N/A

Sponsors & Collaborators

• University of Pennsylvania: lead

Related Publications (1)

• Navathe AS, Volpp KG, Caldarella KL, Bond A, Troxel AB, Zhu J, Matloubieh S, Lyon Z, Mishra Meza A, Sacks L, Nelson C, Patel P, Shea J, Calcagno D, Vittore S, Sokol K, Weng K, McDowald N, Crawford P, Small D, Emanuel EJ. Effect of Financial Bonus Size, Loss Aversion, and Increased Social Pressure on Physician Pay-for-Performance: A Randomized Clinical Trial and Cohort Study. JAMA Netw Open. 2019 Feb 1;2(2):e187950. doi: 10.1001/jamanetworkopen.2018.7950.

  PMID: 30735234 DERIVED

MeSH Terms

Conditions

Diabetes Mellitus

Condition Hierarchy (Ancestors)

Glucose Metabolism Disorders; Metabolic Diseases; Nutritional and Metabolic Diseases; Endocrine System Diseases

Study Officials

• Amol Navathe, MD, PhD

  University of Pennsylvania

  PRINCIPAL INVESTIGATOR

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: NONE
• Purpose: OTHER
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Principal Investigator

Study Record Dates

• First Submitted: December 7, 2015
• First Posted: December 18, 2015
• Study Start: January 1, 2016
• Primary Completion: June 1, 2017
• Study Completion: December 1, 2017
• Last Updated: December 12, 2018

Record last verified: 2018-12

Data Sharing

• IPD Sharing: Will not share