Introducing a method to monitor the impact of introducing value-based payment models; using a Dutch pilot project for coronary artery disease as an example

Abstract Background: Worldwide, the usage of value-based payment (VBP) models is increasing. Empirical studies on the intended and unintended effects of the introduction of a VBP model are however scarce. In this study, we present an approach to monitor the effects of the introduction of VBP models. Moreover, we share the results of a first application of the approach using a Dutch outcome-based payment model for coronary artery disease with limited financial impact to participating hospitals as an example. Methods: A mixed-method approach was developed and applied. This approach consists of online questionnaires and semi-structured interviews regarding the impact of an outcome-based payment model on treatment decisions, the organization of care, and the importance of clinical outcomes in the planning and control cycle of the hospital. In addition, case-mix analyses with real-world data were performed to monitor whether the risk profile of treated patients changed after the introduction of the payment model. Implicated cardiologists and cardiothoracic surgeons discussed the results. Results: The developed approach was implemented successfully. Data were collected and discussed at several time points and led to relevant insights regarding both intended and unintended effects. Fifty-two percent of the respondents on the survey indicated that the VBP model leads to more attention to clinical outcomes within the medical department. Case-mix analyses did not exhibit any signs of risk selection. Conclusions: The developed mixed-method approach is a useful tool, as it creates insights into the desired and undesired effects of the introduction of VBP models. The application of the developed model in other contexts can enrich the frame of reference and provide stakeholders with more insight regarding which results are worrisome and which are not.