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Departamento Gestión de Conocimiento, Monitoreo y Prospección
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Controllable and non-controllable factors to measure performance in primary care practices under Medicare alternative payment models
Indexado
WoS WOS:000700620600001
Scopus SCOPUS_ID:85114390497
DOI 10.1016/J.ORHC.2021.100312
Año 2021
Tipo artículo de investigación

Citas Totales

Autores Afiliación Chile

Instituciones Chile

% Participación
Internacional

Autores
Afiliación Extranjera

Instituciones
Extranjeras


Abstract



We analyze the two recent Medicare alternative payment models, the comprehensive primary care plus (CPC+) and the primary care first (PCF). Both models comprise fee-for-service, traditional capitation, and pay-for-performance (P4P) components. The main objective of these reimbursement models is to advance toward value-based care. However, the models confer some hesitations since the P4P component is based on factors not entirely controlled by the practice, increasing the potential admission of healthier patients and affecting the profit of small primary care practices. We have modified the P4P component in both models to include a non-controllable agent (the hierarchical condition category score) and a controllable factor (the Bice–Boxerman continuity of care index) through a probabilistic classification model to predict hospital admissions. This study aims to determine the impact of adjusting the P4P component, in the CPC+ and PCF reimbursement models, on the profit per team, revenue for performance per team, and severity of admitted patients. We develop a mixed-integer programming formulation and analyze, using a 2k factorial design, the reimbursement models and the main elements of their adjusted P4P components (i.e., the probabilistic classification model coefficients and hospital admission threshold). The results indicate that the coefficients of the probabilistic classification model and the hospital admission threshold have a significant effect on the profit and revenue for performance per team. There is also a tendency of the PCF to admit less severe patients than the CPC+. Yet, the effects are more notable in the PCF payment model because the proportion of P4P in the total revenue under the CPC+ is minimal (16.5% versus <1%). Similarly, the PCF's downside is its sensitivity to P4P changes, displaying high variability in the output variables under analysis.

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Disciplinas de Investigación



WOS
Health Care Sciences & Services
Scopus
Medicine (Miscellaneous)
Management Science And Operations Research
Health Professions (All)
SciELO
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Publicaciones WoS (Ediciones: ISSHP, ISTP, AHCI, SSCI, SCI), Scopus, SciELO Chile.

Colaboración Institucional



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Autores - Afiliación



Ord. Autor Género Institución - País
1 Mendoza-Alonzo, Jennifer Mujer University of South Florida, Tampa - Estados Unidos
UNIV S FLORIDA - Estados Unidos
2 Zayas-Castro, José Hombre University of South Florida, Tampa - Estados Unidos
UNIV S FLORIDA - Estados Unidos
3 Luer-Villagra, Armin Hombre Universidad Nacional Andrés Bello - Chile

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Financiamiento



Fuente
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