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Quality Improvement With Pay-for-Performance Incentives in Integrated Behavioral Health Care

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Unützer, Jürgen, Chan, Ya-Fen, Hafer, Erin, Knaster, Jessica, Shields, Anne, Powers, Diane, Veith, Richard C.·2012·American Journal of Public Health

DOI 10.2105/ajph.2011.300555PMC PMC3483954

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Abstract

Objectives. 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. Methods. 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. Results. 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. Conclusions. 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.

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Authors: Unützer, J., Chan, Y.-F., Hafer, E., Knaster, J., Shields, A., Powers, D., & Veith, R. C.
Affiliations: Washington State Department of Health (US)
Jürgen Unützer, Ya-Fen Chan, Diane Powers, and Richard C. Veith are with the Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle. Erin Hafer is with the Community Health Plan of Washington, Seattle. Jessica Knaster is with Public Health of Seattle and King County, Seattle, WA. Anne Shields is with the Washington State Department of Health, Olympia, WA.
ORCID: Unützer, Jürgen
Powers, Diane
Veith, Richard C.
Venue: American Journal of Public Health
Publisher: American Public Health Association
Published: 2012-06
Volume: 102
Issue: 6
Pages: e41-e45
ISSN: 0090-0036 (ISSN-L)
1541-0048
DOI: 10.2105/ajph.2011.300555
PMC: PMC3483954
OpenAlex: W2103940893
Cited by: 167
References: 19
Citations by year: 2025: 7 · 2024: 9 · 2023: 3 · 2022: 9 · 2021: 7 · 2020: 13 · 2019: 9 · 2018: 15 · 2017: 13 · 2016: 17 · 2015: 20 · 2014: 21 · 2013: 19 · 2012: 5
FWCI: 36.93
Type: journal article
Language: en
Open access: green
www.ncbi.nlm.nih.gov
Locations: American Journal of Public Health (publishedVersion)
PubMed Central (publishedVersion)
PubMed (publishedVersion)
RePEc: Research Papers in Economics (submittedVersion)
Funders: University of Washington
Topics: Health Sciences › Medicine › Family Practice › Primary Care and Health Outcomes
Social Sciences › Economics, Econometrics and Finance › Economics and Econometrics › Healthcare Policy and Management
Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Healthcare Quality and Management
Keywords: performance-based pay, quality improvement, behavioral health integration, depression treatment, community clinics, quality indicators, treatment response, social adversity, substance abuse, mental illness
MeSH terms: Adult, Mental Disorders, Community Health Services, Depression, Female, Follow-Up Studies, Humans, Male, Middle Aged, Physician Incentive Plans, Primary Health Care, Quality of Health Care, Reimbursement, Incentive, United States, Washington, Treatment Outcome, Delivery of Health Care, Integrated

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Quality Improvement With Pay-for-Performance Incentives in Integrated Behavioral Health Care

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