Meh Results for Value-based Care Program in Hawaii

3PC yielded only small quality gains and no significant cost savings. But it is only Year 1.

A value-based care program in Hawaii has shown only small improvements in quality of care measures and no significant cost savings, according to results reported in JAMA yesterday.

The Population-based Payments for Primary Care, or 3PC, has been billed as truer test of value-based care and payment because it  replaces fee-for-service payments with risk-adjusted PMPM payments ranging from $8 to $70. Moreover, shared savings of up to 40% are also supposed to give physicians a stronger incentive to practice valued-based care.

But Amol Navathe, a University of Pennsylvania researcher, and his colleagues reported in JAMA that during its first year, the program yielded only small improvements in quality and no significant difference in the cost of care. The observational study showed that the program did produce a notable reduction in primary care visits. 

One explanation for the marginal effect is that one year is just not enough time for a shift to value-based payment and stronger shared savings incentives to have their intended effect.

"Additional research is needed to assess longer-term outcomes as the program is more fully implemented and to determine whether results are generalizable to other health care markets," they concluded.

Still, these results and others are showing that the influence of value-based payment on the quality and cost of American health care is less than overwhelming.