In 2011, Fairview Health Services, a nonprofit health care system in Minnesota, began replacing its fee-for-service compensation model for primary care providers (PCPs). The new team-based system is focused on improving quality of care, patient experience, and cost containment. Commonwealth Fund–supported researchers asked Fairview PCPs about their experiences with the new model.
What the Study Found
In the new model, performance on quality-of-care measures constitutes 40 percent of compensation; productivity, another 40 percent; patient experience scores, 10 percent; and cost of care, 10 percent (although this last component was not integrated during the study period). The model favors clinic-level performance, with only a small portion of compensation based on individual PCP performance.
Most PCPs reported having a new impetus to improve quality of care. More than half (51%) reported that the compensation model had improved their own patient care and slightly more (59%) reported that their colleagues’ care had improved. The vast majority of Fairview PCPs (88%) said the new model increased how frequently they made sure their patients were up-to-date on quality metrics. They also reported greater collaboration with their team members.
The average number of patients seen each day by Fairview PCPs fell from 20.1 to 18.5. More than a quarter (29%) of PCPs said the model had increased their job satisfaction, but half (52%) said their satisfaction decreased, possibly because of the lack of control they felt over their compensation, the complexity of the model, and changes that were implemented midstream.
Despite the increase in income reported by most of the PCPs in the study, for more than half of PCPs there was a decline in job satisfaction. To aid other health systems that are transitioning to a similar compensation approach, the authors recommend involving clinicians in its design, preparing them for the challenges of team-based compensation, and minimizing the models’ complexity.