Awareness of Payment Reform: a Survey of Patients, Staff, and Providers in Safety Net Primary Care Clinics
- PDF / 200,353 Bytes
- 3 Pages / 595.276 x 790.866 pts Page_size
- 10 Downloads / 180 Views
Hennepin Healthcare, Minneapolis, MN, USA; 2Hennepin Healthcare Research Institute, Minneapolis, MN, USA; 3School of Public Health, University of Minnesota, Minneapolis, MN, USA; 4Allina Health, United Family Medicine, Saint Paul, MN, USA.
J Gen Intern Med DOI: 10.1007/s11606-019-05451-3 © Society of General Internal Medicine 2019
INTRODUCTION
Payment reform has been increasing in the U.S. health care system in recent years. Reforms move away from fee-forservice toward value-based payments, or compensation perpatient tied to care quality goals.1 Value-based payment is hypothesized to achieve the quadruple aim—improved care quality at lower costs with more satisfied patients and providers.2 Value-based payment presents both opportunities and challenges for health care clinics that see majority low-income patients (i.e., the safety net). While offering flexibility to invest in services to address patients’ social needs,3 it may discourage care for costly populations.4 Although evidence suggests costsavings of value-based payment models for low-income, complex populations,5 the study of payment reform has focused on regional impact and rarely details mechanisms of change at the clinic level. Previous measurement of engagement within value-based programs has depended on secondhand reports from leaders,6 not providers or patients, and has not focused on the safety net. Engagement of safety net clinic stakeholders in delivery system transformation is essential for achieving quadruple aim goals and avoiding unintended consequences, but stakeholders must first be aware of payment reform and its connection to changes at the clinic level. To improve understanding of the impact of payment reform on safety net primary care delivery, we evaluated the awareness of patients, staff, and providers of ongoing payment reforms and their perceptions of changes at their clinics in Prior presentations: We presented this data at the Minnesota Academy of Family Physicians Research and Innovation day on March 2, 2019. Received July 12, 2019 Accepted September 27, 2019
one urban region with early adoption of Medicaid value-based payment models.
METHODS
Institutional Review Boards at Allina Health, Hennepin Healthcare, and the University of Minnesota approved this study. First, we conducted interviews with stakeholders to design novel survey questions about patient, staff, and provider awareness of payment reform. We conducted crosssectional surveys of stakeholders at three safety net primary care clinics at two time points 11 months apart (2017 and 2018). We recruited providers and staff at clinic-wide meetings and left paper surveys for those absent. We recruited convenience samples of patients in clinic waiting rooms. We used Stata 15.1 to analyze data and followed the Strengthening of Reporting Observational Studies in Epidemiology (STROBE) guidelines. We conducted chi-squared tests to compare awareness of payment reform among stakeholder groups.
RESULTS
In total, 218 of 388 patients completed surveys (56%), and 302 of 413 staff/p
Data Loading...
