Engaging Primary Care Physicians in Quality Improvement: Lessons from a Payer-Provider Partnership

Article excerpt

EXECUTIVE SUMMARY

A health insurer in Michigan, through its Physician Group Incentive Program, engaged providers across the state in a collection of financially incentivized initiatives to transform primary care and improve quality. We investigated physicians' and other program stakeholders' perceptions of the program through semistructured interviews with more than 80 individuals. We found that activities across five areas contributed to successful provider engagement: (1) developing a vision of improving primary care, (2) deliberately fostering practice-practice partnerships, (3) using existing infrastructure, (4) leveraging resources and market share, and (5) managing program trade-offs Our research highlights effective strategies for engaging primary care physicians in program design and implementation processes and creating learning communities to support quality improvement and practice change.

INTRODUCTION

Despite increased emphasis on value in the U.S. healthcare system, competing interests among primary care physicians often inhibit collaboration and progress for improvement (Goldberg, Mick, Kuzel, Feng, & Love, 2012). And yet, some examples of success can be found. Through several complementary programs, a large payer in Michigan has engaged primary care physicians in the process of quality improvement and system transformation. The "magic bullet" of these efforts is the degree of collaboration achieved among physician practices in local communities, across the state, and with the sponsor. Specifically, beginning in 2008, the state's largest health insurer, Blue Cross Blue Shield of Michigan (BCBSM), encouraged statewide participation in a collection of primary care practice transformation and quality improvement initiatives through its Physician Group Incentive Program (PGIP).

Early data suggest that Michigan's cost and quality indicators are improving relative to other states and other national Blues plans (Share et al" 2011). Our evaluation finds that physicians participating in BCBSM's PGIP are actively engaged in quality improvement and that the way PGIP was designed and implemented contributed to the difference seen in Michigan versus other states. In short, PGIP was collaboratively developed, executed, and enhanced by Michigan primary care physicians, their physician organizations (POs), and BCBSM with the goal of improving primary care quality and population health. Today, PGIP includes more than 17,500 physicians in 40 POs, representing 71% of active primary care physicians and 56% of active specialists in Michigan. Its patient-centered medical home (PCMH) program is the largest in the nation, with more than 2,500 primary care providers from over 775 practices. Furthermore, PGIP is a "fee for value" physician incentive program that rewards POs on the basis of their adoption and achievement of quality metrics. Physicians also receive payments for implementing PCMH capabilities and increased reimbursement for evaluation and management visits. Initial results have been described in detail elsewhere (Share & Mason, 2012); the program has demonstrated success in PCMH implementation and cost reduction and quality improvements.

In our independent analysis, we used qualitative methods to identify how physicians and other stakeholders perceived PGIP and the specific mechanisms used to engage physicians. Through more than 80 semistructured interviews, we highlighted strategies that may be valuable to others working to engage busy clinicians in quality improvement activities. In particular, our study identified efforts to engage primary care physicians who often work in individual or small group settings.

STUDY DATA AND METHODS

Setting

This article reports on primary care physicians' engagement in quality improvement initiatives through PGIP. In this program, BCBSM contracts with 40 distinct POs, which support individual practices that range in size from 25 to more than 1,600 physicians. …