Clinical trial NCT02634879: Behavioral Economics in Provider Incentive Design
Official title: Behavioral Economics in Provider Incentive Design
Study type: INTERVENTIONAL
Overall status: COMPLETED
Phase: NA
Conditions: Diabetes
Lead sponsor: University of Pennsylvania
Sponsor class: OTHER
First posted: 2015-12-18
Enrollment: 83
Sex: ALL
Minimum age (years): 18
Standard ages: ADULT
OLDER_ADULT
Accepts healthy volunteers: no
Allocation: RANDOMIZED
Intervention model: PARALLEL
Primary purpose: OTHER

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.

Detailed description: The key goal of this project is to demonstrate how using behavioral economic principles to inform the structure of provider incentives and the practice environment can improve provider performance, especially in settings that are moving away from fee-for-service reimbursement and fragmented care towards new payment and delivery models that emphasize coordination of care and provider accountability. The project will build upon the recently completed 'Phase 1' project in which a set of behavioral economic approaches to provider performance were identified that could meaningfully improve provider performance, a focused research agenda of high-priority tests of these concepts (i.e., content of this proposal) was developed; and information on how behavioral economics can be used to improve incentives for physicians was disseminated. For this phase, an experimental evaluation will be conducted of the impact of social pressure by varying individual and group incentives and the comparative effectiveness of two loss aversion framing methods (endowment versus performance gap) on provider performance via a multi-arm experiment. We will complement the quantitative evaluations with pre- and post-intervention qualitative surveys of physicians and patients to better understand the influence on behavior change, culture, acceptability of the incentive program, and patient reported outcomes on health and experience.

Eligibility criteria: Inclusion Criteria:

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

Exclusion Criteria:

* N/A

Primary outcomes:
measure: Physician performance
timeFrame: Baseline to 12 months
Secondary outcomes:
measure: Physician Practice Behavior
timeFrame: Baseline to 12 months
measure: Physician Incentive Payouts
timeFrame: Throughout the 12 months
measure: Patient satisfaction
timeFrame: 6 months to 12 months
Other outcomes:
Locations:
Study officials:
affiliation: University of Pennsylvania
name: Amol Navathe, MD, PhD
role: PRINCIPAL_INVESTIGATOR
References:
citation: 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.