Date of Award

5-6-2018

Degree Type

Dissertation

Degree Name

Executive Doctorate in Business (EDB)

Department

Business

First Advisor

Dr. Karen Loch

Second Advisor

Dr. Patricia Ketsche

Third Advisor

Dr. William Custer

Abstract

The regulatory arm of the Center for Medicare and Medicaid Services (CMS) strictly tracks quality compliance via Healthcare Effectiveness Data and Information Set (HEDIS) reporting, which captures rich data in order to drive value-based healthcare delivery. Health plans are empowered to drive quality results via performance-based contracting, and have instituted financial incentive agreements to improve care delivery for the Dual Eligible Medicare Advantage (MA) patient population. As a result, there is enhanced focus on Dual Eligible MA quality, which has received pronounced attention lately.

As a way to improve Dual Eligible MA Primary Care Provider (PCP) quality, financial incentives have been offered by health plans with the expectation of building a high performance, quality driven network. Specific quality measures outlined in this study are identified in relation to the targeted, incentivized providers. A primary objective of the financial incentives is adherence to quality standards monitored by the health plans. Focused healthcare literature has also laid the groundwork for this study. Motivation theory serves as the theoretical lens to answer the question, “Do financial incentives make a difference?” Regulatory pressures continue to shape the healthcare environment. This study focuses on pre-financial incentive and financial incentive periods to assess the positive or negative relationship financial incentives have on Dual Eligible MA PCP quality.

Findings show that Dual Eligible MA PCP quality on average is not improving as a result of financial incentives. Dual Eligible MA PCP quality gap rates as measured by Dual Eligible MA PCP HEDIS quality gaps divided by Dual Eligible MA patients assigned did not show decline, but rather an increase (i.e., 1.90 in 2010 to 2.30 in 2014). This is supported for all quality measures selected in this study. Assessment of HEDIS gaps using a quantitative approach further contributes to the practical healthcare landscape that bridges the gap between theory and practice. Analysis of Dual Eligible MA PCP characteristics, i.e., structure, specialty, and gender, also elicits the need for continued research along the motivation frontier.

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