Can Financial Incentives Make a Difference in Primary Care?

Pay-for-performance may not be as effective in some ways…. 

Rowena J. Dolor, M.D., M.H.S., and Kevin A. Schulman, M.D., of the Duke University School of Medicine shared their thoughts on two randomized trials in the current issue of JAMA regarding the "comparative effectiveness of financial incentives in primary care settings."

They believed that while the two studies provided advancing information on the pay-for-performance strategy, the analyses raised questions on the performance of clinicians and their ability to reach health goals. Furthermore, the studies showed that even when incentives were given in primary care settings, clinical performance gaps were still present. These gaps were found to be a result of "systematic shortcomings rather than an issue with performance at the individual clinician level."

According to Dolor and Schulman, several approaches may be taken to attain success in a population health model, whether it’s technology-based, clinician-focused, patient-centered, etc…. To divide the resources needed in each approach, an economic analysis would be required to determine how to achieve the "greatest increase in population health from optimizing interactions across all of these efforts." This allows there to be more of a focus on primary care service effectiveness rather than primary care practice effectiveness.

JAMA Intern Med. 2013;173(6):427-432. doi:10.1001/jamainternmed.2013.460.