This project uses a sequential mixed-methods research design to identify mechanisms that result in primary care performance improvement for high-cost, high-need patients under a pay-for-value program (Blue Cross Blue Shield of Michigan’s Physician Group Incentive Program). The key components of the project include:
-Quantitative evaluation of structural characteristics that distinguish primary care practices that effectively manage high-cost, high-need patient populations improved from those that did not, such as participation in the Physician Group Incentive Program, organizational size, and proportion of assigned patients in a provider panel that are high-cost, high-need individuals.
-Qualitative exploration of strategies primary care practices use to improve management of high-cost, high-need patient populations, with a focus on organizational learning, motivation and resources. Double blind interviewing will be conducted with practices stratified by low vs. high rates of recent performance improvement. Case studies will be used to synthesize how practices manage high-cost, high-need patients, and understand how variation in organizational strategies pursued affects performance.