IMPACT Project 2 – The impact of clinic-level financial incentives tied to quality target metrics on clinical communication and health care use

Infrequent and low-quality provider recommendations of highly effective cancer prevention services contribute to low coverage among patients ages 9-12 years. Our program team has demonstrated that Announcement Approach Training (AAT) effectively improves provider communication and health care use. A promising tool to expand the impact of AAT is clinic-level financial incentives, which can motivate providers to apply what they learn in the AAT workshop. Financial incentives are increasingly a central part of payment reform efforts focusing on better aligning financial incentives in healthcare systems with quality of care. No studies have adequately established whether financial incentives motivate providers to recommend cancer prevention services for children ages 9-12 years. As part of the proposed P01 Program Project, “Improving Provider Announcement Communication Training (IMPACT),” the goal of this randomized clinical trial (RCT) is to test promising alternatives to motivate providers to improve clinical communication. We propose to examine whether financial incentives tied to clinic-level quality metrics can improve clinical communication and health care use. To achieve this goal, in Aim 1, we will characterize providers’ perceptions of financial incentives tied to improved health care use and behavioral nudges via a national primary care team survey. We will also refine a feedback report to track clinic quality metrics and improvement among providers and clinics. In Aim 2, we will conduct the RCT, randomizing clinics to one of two arms: 1) AAT and 2) AAT plus financial incentive tied to clinic-level improvement in health care use. In Aim 3, we will evaluate intervention implementation, including cost per additional adolescent initiating primary care. This RCT is significant because it will demonstrate whether and how financial incentives improve provider communication and improve target quality metrics. The proposed research addresses the IMPACT Program Project theme of amplifying the impact of a Cancer Control Program to improve clinical communication in healthcare systems via financial incentives to motivate providers to make needed recommendations.