Linking Provider Cost Curves and Care Delivery Practices: Implications for VBP

描述（申请人提供）：保费逐年大幅增长（加州医生组织的年平均增长率为14.6%）导致综合医疗保健协会的健康计划，购买者和医生组织（PO）的多利益相关者群体取代了他们长期以来的P4P计划，该计划只关注质量改进，通过基于价值的采购（VBP）计划，寻求弯曲成本曲线并提高质量。风险收入的百分比将从P4P下的约1%的人头费增加到VBP下的约8%的人头费。该计划定于2013年生效。我们的研究将评估全州IHA VBP计划，该计划有可能弯曲成本曲线，并将代表美国最大的VBP实验之一，目标是200个与六个主要健康计划签约的PO。通过分析PO对新激励结构的行为反应，我们将研究VPB是否，为什么以及在什么情况下弯曲成本曲线的关键国家政策问题。我们将纵向评估的结果包括PO总护理成本（横截面和趋势）及其组成要素（药房、门诊、医院和辅助）、质量绩效、激励支出和护理实践的变化。该项目的数据来自多个来源：来自IHA的护理总成本和质量绩效数据（来自健康计划和PO），来自健康计划的PO的奖励付款，以及我们从PO收集的访谈数据。我们将使用统计方法来生成PO成本曲线，调查解释各种成本配置文件的潜在成本驱动因素，并检查PO对VBP的行为反应，这些反应与他们在4年暴露于VBP的情况下修改（或不修改）其成本轨迹的能力有关。成本曲线提供关于成本水平以及形状和方向的信息（即，轨迹），我们将跟踪PO成本曲线随时间的变化。

DESCRIPTION (provided by applicant): The large and unrelenting year-to-year growth in premiums (median increase of 14.6% a year among physician organizations in California) has led the Integrated Healthcare Association's multi-stakeholder group of health plans, purchasers, and physician organizations (POs) to replace their longstanding P4P program, which focused only on quality improvement, with a value-based purchasing (VBP) program that seeks to bend the cost curve and improve quality. The percent of revenue at risk will increase from the ~1% of capitation payment under P4P to ~8% of capitation payments under VBP. The program is slated to go into effect in 2013. Our study will evaluate the statewide IHA VBP plan, which has the potential to bend the cost curve, and will represent one of the largest VBP experiments in the U.S., targeting 200 POs that contract with six major health plans. By analyzing the behavioral response of POs to the new incentive structure, we will examine the critical national policy issue of whether, why, and under what circumstances VPB bends the cost curve. The outcomes we will evaluate longitudinally include changes in PO total costs of care (both cross-section and trend) and its component elements (pharmacy, ambulatory, hospital, and ancillary), quality performance, incentive payouts, and care delivery practices. Data for the project draws from multiple sources: total cost of care and quality performance data from IHA (derived from health plans and POs), incentive payments made to POs from health plans, and interview data that we collect from the POs. We will use statistical approaches to generate PO cost curves, investigate underlying cost drivers that explain various cost profiles, and examine PO behavioral responses to VBP that were associated with their ability to modify (or not modify) their cost trajectories ovr 4 years of exposure to the VBP. Cost curves provide information on cost levels as well as shape and orientation (i.e., trajectory), and we will track changes in PO cost curves over time.