Quality improvement with pay-for-performance incentives in integrated behavioral health care

• Published in: American journal of public health (1971) Vol. 102; no. 6; pp. e41 - e45
• Main Authors: Unützer, Jürgen, Chan, Ya-Fen, Hafer, Erin, Knaster, Jessica, Shields, Anne, Powers, Diane, Veith, Richard C
• Format: Journal Article
• Language: English
• Published: United States American Public Health Association 01.06.2012
• Subjects: Adult; Clinical outcomes; Collaboration; Community Health Services - standards; Delivery of Health Care, Integrated - organization & administration; Depression - therapy; Drug abuse; Female; Follow-Up Studies; Health care policy; Health facilities; Health services; Humans; Incentives; Integrated approach; Integrated delivery systems; Low income groups; Male; Medical research; Mental depression; Mental disorders; Mental Disorders - therapy; Mental health; Mental health care; Middle Aged; Online Only; Patients; Physician Incentive Plans; Primary care; Primary Health Care - standards; Psychiatrists; Public health; Quality improvement; Quality of Health Care; Reimbursement, Incentive; Suicides & suicide attempts; Treatment Outcome; United States; Washington; United States; Washington
• ISSN: 0090-0036; 1541-0048
• DOI: 10.2105/AJPH.2011.300555

We evaluated a quality improvement program with a pay-for-performance (P4P) incentive in a population-focused, integrated care program for safety-net patients in 29 community health clinics. We used a quasi-experimental design with 1673 depressed adults before and 6304 adults after the implementation of the P4P program. Survival analyses examined the time to improvement in depression before and after implementation of the P4P program, with adjustments for patient characteristics and clustering by health care organization. Program participants had high levels of depression, other psychiatric and substance abuse problems, and social adversity. After implementation of the P4P incentive program, participants were more likely to experience timely follow-up, and the time to depression improvement was significantly reduced. The hazard ratio for achieving treatment response was 1.73 (95% confidence interval=1.39, 2.14) after the P4P program implementation compared with pre-program implementation. Although this quasi-experiment cannot prove that the P4P initiative directly caused improved patient outcomes, our analyses strongly suggest that when key quality indicators are tracked and a substantial portion of payment is tied to such quality indicators, the effectiveness of care for safety-net populations can be substantially improved.