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Paying Patients To Switch: Impact Of A Rewards Program On Choice Of Providers, Prices, And Utilization.

ABSTRACT: Employers and insurers are experimenting with benefit strategies that encourage patients to switch to lower-price providers. One increasingly popular strategy is to financially reward patients who receive care from such providers. We evaluated the impact of a rewards program implemented in 2017 by twenty-nine employers with 269,875 eligible employees and dependents. For 131 elective services, patients who received care from a designated lower-price provider received a check ranging from $25 to $500, depending on the provider's price and service. In the first twelve months of the program we found a 2.1 percent reduction in prices paid for services targeted by the rewards program. The reductions in price resulted in savings of $2.3 million, or roughly $8 per person, per year. These effects were primarily seen in magnetic resonance imaging and ultrasounds, with no observed price reduction among surgical procedures.

SUBMITTER: Whaley CM

PROVIDER: S-EPMC7610174 | biostudies-literature | 2019 Mar

REPOSITORIES: biostudies-literature

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Paying Patients To Switch: Impact Of A Rewards Program On Choice Of Providers, Prices, And Utilization.

Whaley Christopher M CM Vu Lan L Sood Neeraj N Chernew Michael E ME Metcalfe Leanne L Mehrotra Ateev A

Health affairs (Project Hope) 20190301 3

Employers and insurers are experimenting with benefit strategies that encourage patients to switch to lower-price providers. One increasingly popular strategy is to financially reward patients who receive care from such providers. We evaluated the impact of a rewards program implemented in 2017 by twenty-nine employers with 269,875 eligible employees and dependents. For 131 elective services, patients who received care from a designated lower-price provider received a check ranging from $25 to $ ...[more]

PMID: 30830823

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Project description:BACKGROUND:The Veterans Access, Choice and Accountability Act (hereafter, Choice Program) seeks to improve access to care by enabling eligible Veterans to receive care from community providers. Veterans Affairs (VA) primary care providers (PCPs) play a key role in making referrals to community specialists, but their frontline experiences with referrals are not well understood. OBJECTIVE:To understand VA PCPs' experiences referring patients to community specialists while VA works to expand and refine the implementation of the Choice Program. DESIGN:Qualitative study using interview methods. PARTICIPANTS:Semi-structured telephone interviews were conducted with VA primary care providers (N = 72 out of 599 contacted) recruited nationally. APPROACH:Open-ended interview questions elicited PCP perceptions and experiences with referrals to community specialists via the Choice Program. Keywords were identified using automated coding features in ATLAS.ti and evaluated using conventional content analysis to inductively describe the qualitative data. KEY RESULTS:VA PCPs emphasized problems with care coordination and continuity between the VA and community specialists (e.g., "It is extremely difficult for us to obtain and continue continuity of care because there's not much communication with the community specialist"). They described difficulties with tracking the initial referral, coordinating care after receiving community specialty care, accessing community medical records, and aligning community specialists' prescriptions with the VA formulary. CONCLUSIONS:The VA Choice Program provides access to community specialists for VA patients; however, VA primary care providers face challenges tracking referrals to community specialists and in coordinating care. Strategies to improve care coordination between the VA and community providers should focus on providing PCPs with information to follow Veterans throughout the Choice referral process and follow-up.

Project description:Infertility treatments remain expensive and in many countries are covered by little, if any, insurance, raising critical questions concerning how patients and providers view and make decisions regarding these challenges. In-depth semi-structured interviews of approximately 1 hour were conducted with 37 IVF providers and 10 patients (17 physicians, 10 other providers and 10 patients), and were systematically analyzed. These data suggest current insurance policies and legislation pose critical ethical and logistical challenges for both patients and providers. These individuals face multiple uncertainties about costs and insurance, related to unclear causes of fertility, treatment length, costs and outcomes, and odds that insurers will cover expenses. Insurers frequently decline to agree to reimbursement beforehand, and decide only afterwards, case-by-case, generating stress. Patients and providers thus may not be able to predict how best to allocate limited resources. Providers may advocate for patients, but are usually unsuccessful. Patients may adopt several strategies: e.g., moving/seeking treatment elsewhere, switching or feeling "stuck" in jobs because of insurance, seeking "free" medications, going into debt, or using funds intended for other purposes. Patients do not perceive and respond to resource limitations as fixed phenomena-i.e., patients do not see treatment simply as "affordable" or not. Rather, patients face quandaries of how much to keep spending-how much a child is worth-and are forced to make complex risk/benefit calculations. Couples can disagree, straining relationships. In sum, these data, the first to explore how providers and patients struggle, view, and make decisions regarding limited insurance and resources for infertility, raise several critical ethical and policy issues. These data suggest that individuals have difficulty translating profoundly life-altering, deeply personal quests for meaning and fulfillment into purely economic terms. These findings thus have important implications for future policy, practice, research, and patient and provider education.

Project description:BackgroundIn recent years, the information environment for patients to learn about physician quality is being rapidly changed by Web-based ratings from both commercial and government efforts. However, little is known about how various types of Web-based ratings affect individuals' choice of physicians.ObjectiveThe objective of this research was to measure the relative importance of Web-based quality ratings from governmental and commercial agencies on individuals' choice of primary care physicians.MethodsIn a choice-based conjoint experiment conducted on a sample of 1000 Amazon Mechanical Turk users in October 2016, individuals were asked to choose their preferred primary care physician from pairs of physicians with different ratings in clinical and nonclinical aspects of care provided by governmental and commercial agencies.ResultsThe relative log odds of choosing a physician increases by 1.31 (95% CI 1.26-1.37; P<.001) and 1.32 (95% CI 1.27-1.39; P<.001) units when the government clinical ratings and commercial nonclinical ratings move from 2 to 4 stars, respectively. The relative log odds of choosing a physician increases by 1.12 (95% CI 1.07-1.18; P<.001) units when the commercial clinical ratings move from 2 to 4 stars. The relative log odds of selecting a physician with 4 stars in nonclinical ratings provided by the government is 1.03 (95% CI 0.98-1.09; P<.001) units higher than a physician with 2 stars in this rating. The log odds of selecting a physician with 4 stars in nonclinical government ratings relative to a physician with 2 stars is 0.23 (95% CI 0.13-0.33; P<.001) units higher for females compared with males. Similar star increase in nonclinical commercial ratings increases the relative log odds of selecting the physician by female respondents by 0.15 (95% CI 0.04-0.26; P=.006) units.ConclusionsIndividuals perceive nonclinical ratings provided by commercial websites as important as clinical ratings provided by government websites when choosing a primary care physician. There are significant gender differences in how the ratings are used. More research is needed on whether patients are making the best use of different types of ratings, as well as the optimal allocation of resources in improving physician ratings from the government's perspective.

Dataset Information

Paying Patients To Switch: Impact Of A Rewards Program On Choice Of Providers, Prices, And Utilization.

Publications

Paying Patients To Switch: Impact Of A Rewards Program On Choice Of Providers, Prices, And Utilization.

Similar Datasets

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