Transforming Primary Care Payment in Hawaii

NCT02731716 | Active Not Recruiting

• 1 other identifier: 823981
• Study Type: interventional
• Target: 117
• Locations: 0 countries
• Sites: N/A

Brief Summary

To design an innovative payment system that improves upon fee-for-service (FFS), incorporates behavioral economic principles, and improves work satisfaction among primary care physicians (PCPs) while improving quality and reducing health spending at the state level. Second, to test the incremental effectiveness of two additional interventions: (1) shared financial incentives between physicians and poorly controlled diabetes and (2) social comparisons ranking physicians on quality metric performance and total cost of care.

Conditions

Diabetes

Outcome Measures

Primary Outcomes (1)

• Improvement in Provider Performance

  Provider performance on quality metrics will be compared across all three arms.

  1 year

Secondary Outcomes (2)

• Improvement in A1C among poorly controlled diabetics

  6 Months

• Primary Care Spending

  1 year

Study Arms (3)

New Payment Model

EXPERIMENTAL

Providers in the first arm will no longer be paid based upon FFS, but on the new payment model. Providers will receive a PMPM payment for attributed members, a quality incentive payment based upon attainment of sixteen quality metrics, and a possible bonus payment for savings in total cost of care at the provider organization level.

Behavioral: New Payment Model

Social Comparisons

EXPERIMENTAL

Providers will no longer be paid based upon FFS, but on the new payment model. Providers will receive a PMPM payment for attributed members, a quality incentive payment based upon attainment of sixteen quality metrics, and a possible bonus payment for savings in total cost of care at the provider organization level. Providers will also receive weekly emails that will show comparisons of their own performance against their peers within the same provider organization on specific quality measures and total cost of care.

Behavioral: New Payment Model; Behavioral: Social Comparisons

A1c Member/Provider Incentive

EXPERIMENTAL

Providers will no longer be paid based upon FFS, but on the new payment model, which includes a PMPM payment for attributed members, a quality incentive payment based upon attainment of quality metrics, and a possible bonus payment for savings in total cost of care. Providers will also receive weekly emails that will show comparisons of their own performance against their peers within the same provider organization on specific quality measures and total cost of care. There is also a shared incentive between the member and the provider. The member incentive will be a payment made to diabetic patients with an A1C of greater than or equal to 9% who experience a reduction of at least 0.5%. Each participating member and PCP can receive up to $75 per quarter for A1C reduction.

Behavioral: New Payment Model; Behavioral: Social Comparisons; Behavioral: A1c Member/Provider Incentive

Interventions

New Payment Model BEHAVIORAL

Providers will no longer be paid based upon FFS, but on the new payment model, which includes PMPM and quality incentives.

A1c Member/Provider Incentive; New Payment Model; Social Comparisons

Social Comparisons BEHAVIORAL

Providers will receive weekly emails showing comparisons in quality metrics and total cost of care. They will be compared to other providers in their provider organization.

A1c Member/Provider Incentive; Social Comparisons

A1c Member/Provider Incentive BEHAVIORAL

Attributed members and their PCPs will receive up to $75 for a reduction of a1c by 0.5% per quarter (2 quarters).

A1c Member/Provider Incentive

Eligibility Criteria

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

You may qualify if:

• HMSA physicians who are part of a Provider Organization that is participating in the payment transformation pilot.

You may not qualify if:

• Any physician who is not part of a participating Provider Organization.

Sponsors & Collaborators

• University of Pennsylvania: lead
• Hawaii Medical Service Association: collaborator

MeSH Terms

Conditions

Diabetes Mellitus

Condition Hierarchy (Ancestors)

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

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: NONE
• Purpose: HEALTH SERVICES RESEARCH
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: MD, PHD

Study Record Dates

• First Submitted: March 28, 2016
• First Posted: April 7, 2016
• Study Start: April 1, 2016
• Primary Completion: December 1, 2017
• Study Completion (Estimated): July 1, 2026
• Last Updated: August 19, 2025

Record last verified: 2025-08

Data Sharing

• IPD Sharing: Will not share