The Effect of Network-Level Payment Models on Care Network Performance: A Scoping Review of the Empirical Literature

Thomas Reindersma; Sandra Sülz; Kees Ahaus; Isabelle Fabbricotti

doi:10.5334/ijic.6002

Figures & Tables

Table 1

Taxonomy of network-level payment models, adapted from Tsiachristas [17].

PAYMENT MODEL	DEFINITION
*Base payment*
Capitation	Periodic lump sum per enrolled patient for a range of services
Episode-based bundled payment	Payment for medical services delivered during an episode of care
Disease-based bundled payment	Payment for all the care required by a patient for a particular disease over a predefined period
Global payment	Payment for all the services offered to cover the medical needs of a defined population for a specific period of time
*Add-on payment*
Pay-for-performance (P4P)	Payments to providers for meeting predetermined performance indicators
Pay-for-coordination (P4C)	Payment for taking responsibility for coordinating a patient’s care along parts of, or complete, care pathways for a specific period
Risk and gain sharing/Shared savings	Payments are increased if financial targets are met for the wider system/Providers share in savings and losses if financial or quality targets are (not) met

Table 2

Summary of empirical research.

COUNTRY	MAIN PAYMENT MODEL	RESEARCH DESIGN	PAYMENT FLOW
United States (N = 70)	Capitation (N = 4)	Quantitative (N = 66)	To network (N = 68)
Netherlands (N = 4)	Disease-based bundled payment (N = 5)	Mixed (N = 10)	In network (N = 8)
Germany (N = 2)	P4P (N = 8)
	Global payment (N = 59)

Table 3

Evidence quality of included studies.

LEVEL	DESCRIPTION	#
A1	Systematic review
Review of data from multiple RCT studies	0
A2	Randomized trial
Comparative study with (random) intervention and control group design	0
B	Controlled study
B	Trial with intervention and control group and comparisons on outcome
B1 Multiple measurement points	60
B2 One measurement point	5
C	Non-controlled study
	C1 Multiple case, multiple measurement points	4
	C2 Multiple case, one measurement point	1
C3 Single case, multiple measurement points	4
C4 Single case, one measurement point	2
D	Descriptive, non-analytical	0
D	D1 Multiple projects	0
D2 Single project	0
D3 Literature review	0

Table 4

Summary of included articles. Abbreviations: HMO, Health Maintenance Organization; GP, general practitioner; ED, emergency department; HbA1C, average blood glucose levels for last two to three months; LDL(-C), low-density lipoprotein (cholesterol); SUD, substance use disorder; P4P, Pay-for-performance; SNF, skilled nursing facility; AMI, acute myocardial infarction; COPD, chronic obstructive pulmonary disease; CHF, congestive heart failure; ICU, intensive care unit; IRF, inpatient rehabilitation facility; HHA, home health agency; LTC, long-term care; AAA, abdominal aortic aneurysm; CABG, coronary artery bypass grafting; ACO, Accountable Care Organization; FFS, fee-for-service; DMP, disease management program. SBI; Screening and Brief Intervention (for SUD); PDC, proportion of days covered; ESRD, end stage renal disease; AVR, aortic valve replacement; MSSP, Medicare Shared Savings Program; AQC, Alternative Quality Contract; PGPD, Physician Group Practice Demonstration.

REFERENCE #	YEAR	FIRST AUTHOR	METHOD	COUNTRY	PROGRAM	NETWORK CONFIGURATION	PAYMENT MODEL(S)	FLOW	STUDY POPULATION	INTERVENTION N	CONTROL N	INDICATOR	QUALITY OF CARE	UTILIZATION	SPENDING	OTHER	EPOC
42	1995	Schlenker	QN	USA	HMO	Not specified	Capitation	To	Medicare home health beneficiaries	181 patients	1,079 patients	Patient discharge		+			C2
												Home health visits		+
												Cost per patient			+
												Episode length		+
43	1995	Robinson	Mixed	USA	HMO	Integrated physician medical groups in California	Capitation	To	Capitated HMO enrollees in six integrated physician medical groups	Not reported	Not reported	Physician visits		–			C1
44	2014	Marton	QN	USA	Passport (P) and Kentucky Health Select Plan (K)	Primary care practices in regional managed care networks	Capitation + P4P (P) P4P (K)	In	Children enrolled in Medicaid	1,890 patients (P) and 4,273 patients (K)	2,816 patients (P) and 9,317 patients (K)	Outpatient utilization (P/K)		+/+			B1
44	2014	Marton	QN	USA	Passport (P) and Kentucky Health Select Plan (K)	Primary care practices in regional managed care networks	Capitation + P4P (P) P4P (K)	In	Children enrolled in Medicaid	1,890 patients (P) and 4,273 patients (K)	2,816 patients (P) and 9,317 patients (K)	Professional utilization (P/K)		+/–			B1
45	2017	Mandal	QN	USA	HMO	Provider group with 7 clinic locations and 25 primary care specialists	Capitation + risk-and-gain sharing	To	Community-dwelling Medicare Advantage enrollees ≥65 years	1,230 patients	1,230 patients	Office-based visits		+			B1
												ED hospital visits		+
												Inpatient hospital admissions		+
												30-day readmission	0
												60-day readmission	0
												Preventive visits		+
												Screening mammography		+
												Screening colonoscopy		0
48	2011	De Bakker	Mixed	NL	DMP for diabetes	Care groups, consisting of health care providers such as GPs, laboratories, dietitians and medical specialists	Disease-based bundled payment	To	Diabetes patients assigned to care group	Not reported (10 care groups)	Not reported	Collaboration				+	C4
												Process quality				+
												Transparency				+
												GP domination of care groups				–
												Administrative burden				–
												Price variations				–
47	2014	Busse	Mixed	NL	DMP for diabetes	Care groups, consisting of health care providers such as GPs, laboratories, dietitians and medical specialists	Disease-based bundled payment	To	Diabetes patients assigned to care group	Not reported	Not reported	Specialist care use		+			B1
												Control of blood pressure and cholesterol		+
												HbA1C		+
												Regular check-ups		+
												Foot exams		+
												Kidney exams		+
												Eye testing		–
												Total medical spending			–
46	2015	Mohnen	QN	NL	DMP for diabetes	Care groups, consisting of health care providers such as GPs, laboratories, dietitians and medical specialists	Disease-based bundled payment	To	Diabetes patients assigned to care group	20,257 patients	43,754 patients	Curative health care spending			–		B1
49	2021	Karimi	QN	NL	DMP for diabetes, COPD and vascularrisk management (VRM)	Care groups, consisting of health care providers such as GPs, laboratories, dietitians and medical specialists	Disease-based bundled payment	To	Patients enrolled in a bundled payment for diabetes, COPD, or increased vascular risk	807,197 patients (diabetes), 1,039,406 (VRM), 267,843 (COPD)	988,480 patients	Diabetes total cost			–		B1
												Diabetes medical specialist cost			–
												Diabetes primary care cost			+
												Diabetes medication cost			–
												Diabetes bundled payment cost			–
												VRM total cost			–
												VRM medical specialist cost			–
												VRM primary care cost			+
												VRM medication cost			–
												VRM bundled payment cost			–
												COPD total cost			–
												COPD medical specialist cost			–
												COPD primary care cost			+
												COPD medication cost			–
												COPD bundled payment cost			–
50	2021	Navathe	QN	USA	MSSP	Not specified	Disease-based bundled payment	In	Medicare fee-for-service beneficiaries	24,884 patients	70,208 patients	Post discharge institutional spending medical episode (non-ACO/ACO)			+/+		B1
												Medical episode mortality (non-ACO/ACO)	0/0
												Medical episode 90-day readmissions (non-ACO/ACO)	0/+
												Medical episode discharge to SNF/IRF (non-ACO/ACO)		0/0
												Medical episode discharge to HH (non-ACO/ACO)		+/+
												Medical episode length of stay SNF (non-ACO/ACO)		+/+
												Post discharge institutional spending surgical episode (non-ACO/ACO)			+/+
												Surgical episode mortality (non-ACO/ACO)	0/0
												Surgical episode 90-day readmissions (non-ACO/ACO)	+/+
												Surgical episode discharge to SNF/IRF (non-ACO/ACO)		+/+
												Surgical episode discharge to HH (non-ACO/ACO)		+/+
												Surgical episode length of stay SNF (non-ACO/ACO)		+/+
52	2007	Mandel	QN	USA	Not specified	Physician-hospital organization consisting of primary care practices (PCPs)	P4P	To/in	Children with asthma	13,380 patients in 44 PCPs	Not reported	Perfect care delivery	+				C3
52	2007	Mandel	QN	USA	Not specified		P4P	To/in	Children with asthma	13,380 patients in 44 PCPs	Not reported	Influenza vaccination rates	+				C3
51	2006	Levin-Scherz	QN	USA	Partners Community HealthCare (PCHI)	Network composedof 15 regional service organizations	P4P	To	PCHI patients	Variedper measure	Variedper measure	HbA1C screening		+			B1
												Diabetic LDL screening		+
												Nephropathy screening		+
												Diabetic eye exams		+
												Paediatric asthma controller use		0
53	2010	Atkinson	QN	USA	Long Island Health Network	Clinically integrated network of 10 hospital facilities	P4P	In	Not specified	Not reported	Not reported	Quality (overall composite measure)	+				C3
53	2010	Atkinson	QN	USA	Long Island Health Network	Clinically integrated network of 10 hospital facilities	P4P	In	Not specified	Not reported	Not reported	Hospital average length of stay		+			C3
54	2018	Rieckmann	Mixed	USA	Coordinated Care Organization	Integrated financing and service delivery for medical, behavioural, and dental health	P4P	In	Members enrolled in CCO	Not specified	Not specified	SUD screening		+			C1
												SUD treatment initiation		–
												SUD treatment engagement		–
55	2015	Hibbard	Mixed	USA	Fairview Pioneer ACO	PCPs working in a Pioneer accountable care organization	P4P	In	Fairview PCPs	85 respondents	Not applicable	Efforts into increasing patient activation and patient self-management				0	C3
55	2015	Hibbard	Mixed	USA	Fairview Pioneer ACO	PCPs working in a Pioneer accountable care organization	P4P	In	Fairview PCPs	85 respondents	Not applicable	Becoming more patient-centred				0	C3
56	2016	Gleeson	QN	USA	Partner for Kids	Physicians in a paediatric accountable care organization	P4P	In	Community physicians who received P4P incentives	203 physicians across 50 practices	2763 physicians across 82 practices	Adolescent well care visits		+			B1
												Well child visits at 3–6 years¹		+/0
												Asthma at 12–18 years	0/0
												Asthma at 5–11 years	0/0
												Immunizations (adolescents)	0/–
												Meningococcal immunizations (adolescents)	0/–
												Td/Tdap immunizations (adolescents)	0/–
												Immunizations (children)	0/–
												DTP immunizations (children)	+/–
												Hepatitis A immunizations (children)	0/–
												IPV immunizations (children)	+/–
												MMR immunizations (children)	0/0
												Pneumococcal conjugate immunizations (children)	+/0
												Varicella immunizations (children)	0/–
												Pharyngitis	0/0
												Upper respiratory infection	0/0
												ADHD maintenance		0/0
												ADHD initiation		0/0
												Lead screening		+/0
												Influenza	0/0
												Rotavirus	+/–
57	2020	Ganguli	QN	USA	MSSP	Not specified	P4P	In	ACOs using cost reduction-based specialist compensation (P4P)	41 ACOs	119 ACOs	Shared savings			0		B2
												Outpatient spending			0
												Specialist visits		0
115	2017	Afendulis	Mixed	USA	Total Cost and Care Improvement (TCCI)	Primary care physician panels, consisting of at least 5-15 physicians and 1000 patients	Global payment + shared savings + pay-for-coordination	To	CareFirst BlueCross BlueShield Total Care and Cost Improvement Program enrollees	298,463 patients	537,778 patients	Outpatient spending			0		B1
												Specialist visits		0
												Primary care visits		0
												Inpatient spending			0
												Outpatient spending			0
												Total spending			0
103	2017	Stuart	QN	USA	AQC	Not reported	Global payment + P4P + shared savings	To	BCBSMA HMO and POS (point of service) plan enrollees	10,817 patients	50,576 patients	SUD service utilization ²		0/+			B1
												SUD spending			0/0
												SUD identification		0/+
												SUD initiation		0/+
												SUD engagement		0/0
106	2013	McWilliams	QN	USA	AQC	Not reported	Global payment + P4P + shared savings	To	Elderly FFS Medicare beneficiaries in Massachusetts treated by AQC-affiliated providers	417,182 person-years	1,344,143 person-years	Total spending			+		B1
												Admission rate for ambulatory care–sensitive conditions related to cardiovascular disease or diabetes		0
												30-day readmission	0
												Mammography screening		0
												LDL-C testing (diabetes and cardiovascular)		+
												HbA1C testing		0
												Diabetes retinal examination		0
107	2011	Song	QN	USA	AQC	Not reported	Global payment + P4P + shared savings	To	Enrollees whose PCPs were in the AQC system	380,142 enrollees	1,351,446 enrollees	Medical spending			+		B1
												Paediatric care quality	+
												Adult preventive care quality	0
												Chronic care management quality	+
108	2012	Song	QN	USA	AQC	Not reported	Global payment + P4P + shared savings	To	BCBSMA enrollees	612,547 enrollees	1,339,798 enrollees	Medical spending			+		B1
												Paediatric care quality	+
												Adult preventive care quality	+
												Chronic care management quality	+
109	2014	Song	QN	USA	AQC	Not reported	Global payment + P4P + shared savings	To	Persons in four cohorts of AQC organizations, defined by first contract year: 2009, 2010, 2011, 2012	1,348,235 enrollees	966,813 enrollees	Medical spending			+		B1
												Chronic disease management quality	+
												Adult preventive care quality	+
												Paediatric care quality	+
104	2016	Huskamp	QN	USA	AQC	Not reported	Global payment + P4P + shared savings	To	Adults between 18–64 years enrolled in BCBSMA HMO or POS (point of service) plans	533,568 person-years	2,999,221 person-years	Any tobacco cessation treatment use		+			B1
												Varenicline or bupropion use		+
												Nicotine replacement therapy use		0
												Tobacco cessation counselling visit use		+
												Combination therapy (pharmacotherapy plus counselling) use		+
												≥90-day supply of tobacco cessation		+
112	2014	Afendulis	QN	USA	AQC	Not reported	Global payment + P4P + shared savings	To	BCBSMA HMO and POS (point of service) plan enrollees	332,624 enrollees	1,296,399 enrollees	Drug utilization		0			B1
112	2014	Afendulis	QN	USA	AQC	Not reported	Global payment + P4P + shared savings	To	BCBSMA HMO and POS (point of service) plan enrollees	332,624 enrollees	1,296,399 enrollees	Drug spending			0		B1
113	2018	Donohue	QN	USA	AQC	Not reported	Global payment + P4P + shared savings	To	Individuals with alcohol use disorders (AUD) and/or opioid use disorders (OUD)	8,956 person-years	40,884 person-years	Medication treatment use		0			B1
110	2014	Chien	QN	USA	AQC	Not reported	Global payment + P4P + shared savings	To	BCBSMA HMO enrollees 0-21 years with and without special health care needs (CSHCN)	126,975 enrollees	415,331 enrollees	Quality measures tied to P4P	+				B1
												Quality measures not tied to P4P	0
												Medical spending			0
111	2017	Pimperl	QN	DE	Gesundes Kinzigtal	Not reported	Global payment + P4P + shared savings	To	Gesundes Kinzigtal enrollees	Varied per measure	Varied per measure	Mortality rate	0				B1
												Average age at time of death	+
												Years of potential life lost	+
105	2012	Hildebrandt	QN	DE	Gesundes Kinzigtal	Population-wide integrated care system that covers all sectors and indications of care with a group of providers	Global payment + P4P + shared savings	To	Gesundes Kinzigtal enrollees	Varied per measure	Varied per measure	Hospitalization		+			B1
105	2012	Hildebrandt	QN	DE	Gesundes Kinzigtal		Global payment + P4P + shared savings	To	Gesundes Kinzigtal enrollees	Varied per measure	Varied per measure	Medical spending			+		B1
114	2017	Blewett	Mixed	USA	Integrated Health Partnership Minnesota	Integrated health partnerships deliver the full scope of primary care services, and coordinate access to specialty providers and hospitals	Global payment + P4P + shared savings	To	Minnesota Health Care Program enrollees	Not reported	Not reported	Forging of community partnerships				+	C4
114	2017	Blewett	Mixed	USA	Integrated Health Partnership Minnesota		Global payment + P4P + shared savings	To	Minnesota Health Care Program enrollees	Not reported	Not reported	Service integration				+	C4
58	2014	Sandberg	Mixed	USA	Hennepin Health	Hennepin County Human Services and Public Health Department; Hennepin County Medical Center, NorthPoint Health and Wellness Center, Metropolitan Health Plan (HMO), all covering physical, behavioural and social services.	Global payment + shared savings	To	Adults without dependent children	Not reported	Not reported	ED visits		+			C3
												Outpatient visits		+
												Hospitalization		0
												Patients receiving optimal diabetes, vascular and asthma care	+
41	2017	Narayan	QN	USA	MSSP	Not reported	Global payment + shared savings	To	Medicare beneficiaries in ACOs	5,329,831 beneficiaries	Not reported	Mammography screening use		+			C1
40	2018	Fraze	QN	USA	MSSP	Not reported	Global payment + shared savings	To	MSSP ACOs	162 ACOs	Not reported	All-or-nothing diabetes composite	+				C1
												HbA1C controlled	+
												LDL controlled	+
												Blood pressure <140/90	+
												Tobacco non-use	+
												Aspirin use	+
59	2014	Pope	Mixed	USA	PGPD	Not reported	Global payment + shared savings	To	Beneficiaries assigned to PGPs	1,776,387 person-years	1,579,080 person-years	Medical spending			+		B1
												Hospitalizations		+
												ED visits		+
												HbA1C testing		+
												LDL-C testing		+
												Medical attention for nephropathy	+
												Diabetes eye exam		+
												Left ventricular ejection fraction testing		0
												Lipid profile		+
												Breast cancer screening		+
90	2019	Kim	QN	USA	MSSP	Not reported	Global payment + shared savings	To	Medicare FFS beneficiaries with a cancer diagnosis who were 66 years or older and died in 2013-2014	9,033 beneficiaries	9,033 beneficiaries	≥1 ICU admission (Aggressive end-of-life care)		–			B2
												≥2 Hospitalizations (Aggressive end-of-life care)		+
												≥2 ED visits (Aggressive end-of-life care)		0
												Chemotherapy ≤2 weeks (Aggressive end-of-life care)		0
												No hospice or enrolment ≤3 days (Aggressive end-of-life care)		0
91	2014	Colla	QN	USA	PGPD	Not reported	Global payment + shared savings	To	FFS Medicare patients assigned to PGPs	819,779 patients	934,621 patients	Discretionary carotid imaging use		0			B1
												Discretionary coronary imaging use		0
												Discretionary carotid procedures use		0
												Discretionary coronary procedures use		0
												Non-discretionary carotid procedures use		0
												Non-discretionary coronary procedures use		0
60	2019	Rutledge	Mixed	USA	Medicaid ACO	Not reported	Global payment + P4P + shared savings	To	ACOs in Maine, Minnesota and Vermont	3 ACOs	Not specified	Primary care provider visits (Maine, Minnesota, Vermont)		–/–/0			B1
												Acute inpatient hospitalizations (Maine, Minnesota, Vermont)		+/–/+
												ED visits (Maine, Minnesota, Vermont)		+/+/+
												30-day readmissions (Maine, Minnesota, Vermont)	0/+/0
												HbA1C testing (Maine, Minnesota)		0/+
												Medication adherence for depression (Maine, Minnesota)	0/–
												Developmental screening (Vermont)		+
												Total spending (Maine, Minnesota, Vermont)			0/0/+
												Inpatient spending (Maine, Minnesota, Vermont)			0/0/+
												Professional spending (Maine, Minnesota, Vermont)			0/+/+
												Pharmaceutical spending (Maine, Vermont)			0/+
61	2019	Borza	QN	USA	MSSP	Not reported	Global payment + shared savings	To	Patients undergoing common surgical procedures at ACO-affiliated hospitals	80,501 patients	348,774 patients	Overall 30-day readmission	+				B1
												Readmission after AAA repair	0
												Readmission after colectomy	0
												Readmission after cystectomy	0
												Readmission after Prostatectomy	0
												Readmission after lung resection	0
												Readmission after total knee arthroplasty	+
												Readmission after total hip arthroplasty	0
101	2019	Diana	QN	USA	Pioneer, MSSP	Not reported	Global payment + shared savings	To	ACO-affiliated hospitals	615 hospitals	2,847 hospitals	Communication with nurses (patient experience) (Pioneer/MSSP)				+/0	B2
												Communication with doctors (patient experience) (Pioneer/MSSP)				+/0
												Responsiveness of hospital staff (patient experience) (Pioneer/MSSP)				0/0
												Pain management (patient experience) (Pioneer/MSSP)				0/0
												Communication about medications (patient experience) (Pioneer/MSSP)				0/0
												Cleanliness of hospital environment (patient experience) (Pioneer/MSSP)				0/0
												Quietness of hospital environment (patient experience) (Pioneer/MSSP)				0/0
												Discharge information (patient experience) (Pioneer/MSSP)				0/0
												Overall hospital rating (patient experience) (Pioneer/MSSP)				0/0
												Recommend the hospital (patient experience) (Pioneer/MSSP)				0/0
92	2019	Trinh	QN	USA	MSSP	Not reported	Global payment + shared savings	To	FFS, non-HMO beneficiaries	51,980 beneficiaries	222,800 beneficiaries	Rates of prostate specific antigen screening		0			B1
92	2019	Trinh	QN	USA	MSSP	Not reported	Global payment + shared savings	To	FFS, non-HMO beneficiaries	51,980 beneficiaries	222,800 beneficiaries	Rates of prostate biopsy		0			B1
83	2017	Zhang	QN	USA	Pioneer	Not reported	Global payment + shared savings	To	FFS Medicare beneficiaries	316,366 beneficiaries	559,241 beneficiaries	Medicare Part D drug spending			0		B1
												Total prescriptions filled		0
												Medicare Part A/B medical spending			+
62	2017	Winblad	QN	USA	Pioneer, MSSP	Not reported	Global payment + shared savings	To	ACO-affiliated hospitals	226 hospitals	1,844 hospitals	30-day overall adjusted rehospitalization rate (MSSP/Pioneer)	+/+				B1
63	2019	Kaufman	QN	USA	MSSP	Not reported	Global payment + shared savings	To	MSSP hospitals	273 hospitals	1,490 hospitals	Discharge to home		–			B1
												30-day all-cause readmissions	0
												Hospital length of stay		0
												Days in the community	0
												Mortality	0
												Recurrent stroke within 1 year of hospitalization	0
64	2019	Bain	QN	USA	MSSP	Not reported	Global payment + shared savings	To	MSSP hospitals	233 hospitals	3,100 hospitals	Probability of discharge to one-star (low-rated) SNFs	0				B1
64	2019	Bain	QN	USA	MSSP	Not reported	Global payment + shared savings	To	MSSP hospitals	233 hospitals	3,100 hospitals	Probability of discharge to five-star (high-rated) SNFs	+				B1
93	2018	Resnick	QN	USA	MSSP	Not reported	Global payment + shared savings	To	Medicare Part A and B beneficiaries > 65 years	4,989,210 beneficiary-years	12,263,135 beneficiary-years	Breast cancer screening use		–			B1
												Colorectal cancer screening use		+
												Prostate cancer screening use		+
65	2018	Kim	QN	USA	MSSP	Not reported	Global payment + shared savings	To	MSSP hospitals	Varied per measure	Varied per measure	30-day hospital-wide all cause readmission rates	+				B1
												30-day readmissions rates for AMI	0
												30-day readmissions rates for heart failure	+
												30-day readmissions rates for pneumonia	+
77	2019	Cole	QN	USA	MSSP	Not reported	Global payment + shared savings	To	Medicare Part A and B beneficiaries ≥ 67 years with prostate cancer	3,297 beneficiaries	24,088 beneficiaries	Radical prostatectomy spending			0		B1
												Radiation therapy (EBRT, IMRT, Brachytherapy) spending			0
												Expectant management (no surgery, radiation treatment within the first 180 days after diagnosis) spending			0
66	2016	Busch	QN	USA	Pioneer, MSSP	Not reported	Global payment + shared savings	To	Medicare beneficiaries ≥ 18 years with mental health illness	Not specified	Not specified	All mental health care spending (Pioneer 2012 performance year/Pioneer 2013 performance year/MSSP 2012 entry cohort/MSSP 2013 entry cohort)			+/0/0/0		B1
												Outpatient mental health care spending (Pioneer 2012 performance year/Pioneer 2013 performance year/MSSP 2012 entry cohort/MSSP 2013 entry cohort)			0/0/0/0
												ED visits with mental health diagnosis spending (Pioneer 2012 performance year/Pioneer 2013 performance year/MSSP 2012 entry cohort/MSSP 2013 entry cohort)			+/0/0/0
												Inpatient admissions with mental health diagnosis spending (Pioneer 2012 performance year/Pioneer 2013 performance year/MSSP 2012 entry cohort/MSSP 2013 entry cohort)			+/0/0/0
												30-day mental health readmissions (Pioneer 2012 performance year/Pioneer 2013 performance year/MSSP 2012 entry cohort/MSSP 2013 entry cohort)	0/0/0/0
												Outpatient mental health follow-up within 7 days of discharge (Pioneer 2012 performance year/Pioneer 2013 performance year/MSSP 2012 entry cohort/MSSP 2013 entry cohort)	0/0/0/0
												Identified as having a depressive disorder (Pioneer 2012 performance year/Pioneer 2013 performance year/MSSP 2012 entry cohort/MSSP 2013 entry cohort)	0/0/–/0
67	2015	McWilliams	QN	USA	Pioneer	Not reported	Global payment + shared savings	To	Fee-for-service Medicare beneficiaries	768,054 beneficiary-years	19,152,460 beneficiary-years	Total spending			+		B1
												30-day readmissions	0
												Hospitalizations for ambulatory-care sensitive conditions		0
												CHF hospitalizations		0
												COPD or asthma hospitalizations		0
												Cardiovascular disease or diabetes hospitalizations		0
												Screening mammography (for women 65–69 years)		0
												HbA1C testing		+
												LDL-C testing		+
												Diabetic retinal examination		+
68	2016	McWilliams	QN	USA	MSSP	Not reported	Global payment + shared savings	To	Fee-for-service Medicare beneficiaries	884,810 (2012 cohort) and 1,015,722 beneficiary-years (2013 cohort)	10,924,440 (2012 cohort) and 14,587,259 beneficiary-years (2013 cohort)	Total spending (2012/2013 entry cohort)			+/0		B1
												30-day readmissions	0
												Hospitalizations for ambulatory-care sensitive conditions		0
												CHF hospitalizations		0
												COPD or asthma hospitalizations (2012/2013 entry cohort)		+/0
												Cardiovascular disease or diabetes hospitalizations		0
												Screening mammography (for women 65–69 years)		0
												HbA1C testing		0
												LDL-C testing (2012/2013 entry cohort)		+/0
												Diabetic retinal examination (2012/2013 entry cohort)		0/+
												Low-value services provided		0
79	2018	Lam	QN	USA	MSSP	Not reported	Global payment + shared savings	To	Medicare FFS beneficiaries ≥ 65 years with cancer	388,784 patients	233,296 patients	Lung cancer spending			0		B1
												Hematologic cancer spending			0
												Gastrointestinal cancer spending			0
												Breast cancer spending			0
												Genitourinary cancer spending			0
												Gynaecologic cancer spending			0
												Head and neck cancer spending			0
												Sarcoma spending			0
												Melanoma spending			0
												Central nervous system cancer spending			0
												Metastatic disease (primary unknown) spending			0
												Total spending			0
												Inpatient spending			0
												Outpatient cancer spending			0
												Physician services spending			0
												SNF spending			0
												HHA spending			0
												Hospice spending			0
												Radiation therapy spending			0
												Chemotherapy spending			0
69	2018	Duggal	QN	USA	Pioneer, MSSP	Not reported	Global payment + shared savings	To	ACO-affiliated hospitals	129 Pioneer-affiliated hospitals and 342 MSSP-affiliated hospitals	3,907 hospitals	Heart failure 30-day readmission rate (MSSP/Pioneer)	+/0				B1
												AMI 30-day readmission rate (MSSP/Pioneer)	0/0
												Pneumonia 30-day readmission rate (MSSP/Pioneer)	0/0
81	2018	McWilliams	QN	USA	MSSP	Physician-group ACOs (narrow scope of provided services) and hospital-integrated ACOs (wider scope of provided services)	Global payment + shared savings	To	Fee-for-service Medicare beneficiaries	Hospital-integrated ACOs (132) and physician-group ACOs (203)	Not specified	Physician group ACO spending (2012/13/14 entry cohort)			+/+/+		B1
81	2018	McWilliams	QN	USA	MSSP		Global payment + shared savings	To	Fee-for-service Medicare beneficiaries		Not specified	Hospital-integrated ACO spending (2012/13/14 entry cohort)			+/0/0		B1
94	2019	Modi	QN	USA	MSSP	Not reported	Global payment + shared savings	To	Medicare part A and B FFS beneficiaries ≥ 66 years undergoing meniscectomy, vertebroplasty or hip fracture procedure	21,486 meniscectomy, 12,521 vertebroplasty and 13,930 hip fracture patients	54,770 meniscectomy, 32,018 vertebroplasty and 36,830 hip fracture patients	Arthroscopic partial meniscectomy (low-value procedure) use		0			B1
94	2019	Modi	QN	USA	MSSP	Not reported	Global payment + shared savings	To				Vertebroplasty (low-value procedure) use		0			B1
70	2016	Herrel	QN	USA	MSSP	Not reported	Global payment + shared savings	To	Patients aged 66 to 99 years that underwent major cancer surgery for nine solid organ cancers	19,439 patients	365,080 patients	30-day mortality	0				B1
												30-day readmissions	0
												30-day major complications	0
												Hospital length of stay	0
76	2018	Borza	QN	USA	MSSP	Not reported	Global payment + shared savings	To	Medicare part A and B FFS beneficiaries ≥ 66 years with prostate cancer	5,065 patients	27,946 patients	Treatment rate in highest mortality risk (overtreatment)		+			B1
												Overall payments			0
												Payments in highest mortality risk			0
78	2016	Colla	QN	USA	Pioneer, MSSP	Not reported	Global payment + shared savings	To	(1) Medicare part A and B FFS beneficiaries and (2) Medicare part A and B FFS beneficiaries ≥ 66 years with multiple clinical conditions (clinically vulnerable)	Not specified	Not specified	Total spending (Pioneer 2012 entry cohort/MSSP 2012 entry cohort/MSSP 2013 entry cohort)			+/+/+		B1
78	2016	Colla	QN	USA	Pioneer, MSSP	Not reported	Global payment + shared savings	To		Not specified	Not specified	Spending among clinically vulnerable beneficiaries (Pioneer 2012 entry cohort/MSSP 2012 entry cohort/MSSP 2013 entry cohort)			+/+/+		B1
95	2018	Resnick	QN	USA	MSSP	Not reported	Global payment + shared savings	To	Medicare Part A and B beneficiaries > 65 years	13,460,798 person-years	40,010,199 person-years	Breast cancer screening use among appropriate candidates		+			B1
												Colorectal cancer screening use among appropriate candidates		+
												Prostate cancer screening use among appropriate candidates		0
82	2015	Schwartz	QN	USA	Pioneer	Not reported	Global payment + shared savings	To	Medicare Part A and B beneficiaries	693,218 person-years	17,453,423 person-years	Total low-value services use		+			B1
												Total low-value services spending			+
												Cancer screening use		+
												Testing use		+
												Preoperative services use		0
												Imaging use		+
												Cardiovascular tests and procedures use		+
												Other invasive procedures use		0
												Higher-priced low-value services use		0
												Lower-priced low-value services use		+
												More patient sensitive low-value services use		+
												Less patient sensitive low-value services use		+
80	2017	McWilliams	QN	USA	MSSP	Not reported	Global payment + shared savings	To	Medicare Part A and B beneficiaries	Not specified	Not specified	SNF spending (2012/2013/2014 entry cohort)			+/+/0		B1
71	2019	Markovitz	QN	USA	MSSP	Not reported	Global payment + shared savings	To	Medicare FFS beneficiaries	835,100 beneficiaries	Not reported	Total spending			0		B1
												HbA1C testing (% meeting quality indicator)	0
												LDL-C testing (% meeting quality indicator)	–
												Diabetic retinal examination (% meeting quality indicator)	0
												All 3 diabetes measures (% meeting quality indicator)	0
												Mammography (% meeting quality indicator)	0
96	2018	Barnett	QN	USA	MSSP	Not reported	Global payment + shared savings	To	Medicare FFS Part A and B beneficiaries	Not specified	Not specified	All specialist visits in primary care oriented ACOs (2012/2013/2014 entry cohort)		+/0/0			B1
												All specialist visits in specialty oriented ACOs (2012/2013/2014 entry cohort)		0/0/0
												New specialist visits in primary care oriented ACOs (2012/2013/2014 entry cohort)		+/0/+
												New specialist visits in specialty oriented ACOs (2012/2013/2014 entry cohort)		0/0/0
97	2017	McWilliams	QN	USA	MSSP	Not reported	Global payment + shared savings	To	Medicare FFS Part A, B and D beneficiaries with cardiovascular disease or diabetes	Not specified	Not specified	Statin use (2012/2013/2014 entry cohort)		0/0/0			B1
												Statin PDC (2012/2013/2014 entry cohort)		0/0/0
												ACE inhibitor/ARB use (2012/2013/2014 entry cohort)		0/0/0
												ACE inhibitor/ARB PDC (2012/2013/2014 entry cohort)		0/0/0
												β-Blockers use (2012/2013/2014 entry cohort)		0/0/0
												β-Blockers PDC (2012/2013/2014 entry cohort)		+/0/0
												Thiazide diuretics use (2012/2013/2014 entry cohort)		0/+/0
												Thiazide diuretics PDC (2012/2013/2014 entry cohort)		0/0/0
												Calcium channel blockers use (2012/2013/2014 entry cohort)		0/0/0
												Calcium channel blockers PDC (2012/2013/2014 entry cohort)		0/0/0
												Metformin use (2012/2013/2014 entry cohort)		0/0/0
												Metformin PDC (2012/2013/2014 entry cohort)		+/+/0
72	2015	Nyweide	QN	USA	Pioneer	Not reported	Global payment + shared savings	To	Medicare FFS beneficiaries	675,712 beneficiaries in 2012 and 806,258 beneficiaries in 2013	13,203,694 beneficiaries in 2012 and 12,134,154 beneficiaries in 2013	Total Medicare spending (2012/2013 performance year)			+/+		B1
												All inpatient hospital (Part A) spending (2012/2013 performance year)			+/+
												Physician (Part B) spending (2012/2013 performance year)			+/+
												Hospital outpatient spending (2012/2013 performance year)			+/0
												SNF spending (2012/2013 performance year)			+/0
												Home health spending (2012/2013 performance year)			+/0
												Hospice spending (2012/2013 performance year)			+/0
												Durable medical equipment spending (2012/2013 performance year)			+/+
												Acute care inpatient days (2012/2013 performance year)		+/+
												Inpatient admissions through ED (2012/2013 performance year)		+/+
												IRF or LTC facility days (2012/2013 performance year)		0/+
												All-cause 30-day readmissions (2012/2013 performance year)	0/0
												Post discharge physician visits within 7 days (2012/2013 performance year)	+/+
												Post discharge physician visits within 14 days (2012/2013 performance year)	0/+
												Post discharge physician visits within 30 days (2012/2013 performance year)	0/0
												Primary care evaluation and management visits (2012/2013 performance year)		+/+
												Procedures use (2012/2013 performance year)		+/+
												Imaging services use (2012/2013 performance year)		+/+
												Tests use (2012/2013 performance year)		+/+
												ED visits (2012/2013 performance year)		+/+
												Observation stays (2012/2013 performance year)		0/–
												SNF days (2012/2013 performance year)		+/0
												Home health visits (2012/2013 performance year)		+/0
												Hospice days (2012/2013 performance year)		+/0
98	2018	Lin	QN	USA	MSSP	Not reported	Global payment + shared savings	To	ACO-affiliated rural health clinics (RHCs)	19 RHCs	484 RHCs	Risk-adjusted diabetes hospitalization rate		0			B2
73	2013	Colla	QN	USA	PGPD	Not reported	Global payment + shared savings	To	Medicare FFS beneficiaries with cancer	123,249 beneficiaries	865,532 beneficiaries	Acute care spending			+		B1
												Imaging spending			0
												Deaths occurring in hospital	0
84	2019	Lam	QN	USA	MSSP	Not specified	Global payment + shared savings	To	ACO cancer decedents	12,248 patients	12,248 patients	Total spending			0		B1
												Inpatient spending			0
												Outpatient spending			0
												Physician services spending			0
												SNF spending			0
												Home health spending			0
												Hospice spending			0
												Radiation therapy spending			0
												Chemotherapy spending			0
												≥1 Emergency room visits (180 days/30 days prior to death)		0/0
												≥1 Inpatient hospitalizations (180 days/30 days prior to death)		–/0
												≥1 ICU admission (180 days/30 days prior to death)		0/0
85	2020	Bakre	QN	USA	MSSP	Not specified	Global payment + shared savings	To	Medicare fee-for-service beneficiaries on long-term dialysis	26,694 patients	167,817 patients	Total spending			+		B1
99	2021	Modi	QN	USA	MSSP	Not specified	Global payment + shared savings	To	ACO hospitals	707 hospitals	1,770 hospitals	AAA treatment rate		0			B1
												AVR treatment rate		0
												Carotid endarterectomy/stent treatment rate		0
												Colectomy treatment rate		0
												Lung lobectomy treatment rate		0
												Prostatectomy treatment rate		0
												Proportion of AAA surgery using EVAR				0
												Proportion of AVR using TAVR				0
												Proportion of carotid surgery using stenting				0
												Proportion of colectomy surgery using minimally invasive approach				0
												Proportion of lobectomy surgery using minimally invasive approach				0
												Proportion of prostatectomy using minimally invasive approach				0
86	2021	Chang	QN	USA	MSSP	Not specified	Global payment + shared savings	To	Long-term nursing home Medicare fee-for-service beneficiaries	121,690 patients	121,690 patients	Evaluation & management visits		0			B2
												Proportion of evaluation & management visits to primary care physicians		+
												Total admissions		+
												ACSC admissions		+
												30-day readmissions		0
												Observation stays		0
												ED visits		+
												Total spending			0
87	2021	Erfani	QN	USA	Medicare ACO	Not specified	Global payment + shared savings	To	Medicare fee-for-service beneficiaries aged 65 years or older with cancer	517,623 patients	348,909 patients	Lung cancer spending			0		B1
												Hematologic cancer spending			0
												Gastrointestinal cancer spending			0
												Breast cancer spending			0
												Genitourinary cancer spending			0
												Gynaecologic cancer spending			0
												Head and neck cancer spending			0
												Sarcoma spending			0
												Melanoma spending			0
												Central nervous system cancer spending			0
												Metastatic disease (primary unknown) spending			0
100	2021	Acevedo	QN	USA	MSSP	Not specified	Global payment + shared savings	To	Medicare beneficiaries	853,953 patients with disability (D) and 2,917, 299 patients aged 65 years or older³ (65)	1,675,928 and 5,492,387 patients	Any outpatient mental health visits (D/65)		+/–			B1
												Any outpatient substance use visits (D/65)		+/0
												Any inpatient mental health stays (D/65)		+/+
												Any inpatient substance use stays (D/65)		+/0
												Number of inpatient mental health visits (D/65)		+/+
												Number of inpatient substance use visits (D/65)		0/–
												Adequate care for patients with depression (D/65)	–/–
102	2020	Lee	QN	USA	MSSP	Not specified	Global payment + shared savings	To	Vulnerable ACO beneficiaries in physician group panels	1,024,833 patients	2,912,043 patients	Proportion of black patients				0	B1
												Proportion of patients that are dually enrolled in Medicare and Medicaid				0
												Proportion of patients that live in areas with higher poverty rates				0
												Proportion of patients that live in areas with higher unemployment rates				0
89	2020	McWilliams	QN	USA	MSSP	Not specified	Global payment + shared savings	To	ACOs across different entry cohorts	114 ACOs (2012 entry cohort), 106 (2013), 115 (2014)	Not specified	Spending (2012 entry cohort) (2013/14/15)			0/+/+		B1
												Spending (2013 entry cohort) (2013/14/15)			0/+/+
												Spending (2014 entry cohort) (2014/15)			0/0
75	2019	Zhang	QN	USA	Commercial ACO	HMO, large independent practice association of physicians and hospital system	Global payment + shared savings	To	Enrolled members of commercial HMO	40,483 patients	20,275 patients	Inpatient and outpatient payments (2010/11/12/13/14)			–/–/0/0/0
												PCP visits (2010/11/12/13/14)		0/0/0/–/–
												Specialist visits (2010/11/12/13/14)		–/–/–/–/–
												ED visits (2010/11/12/13/14)		0/0/–/0/0
												Inpatient admissions (2010/11/12/13/14)		0/0/0/0/–
												30-day readmissions (2010/11/12/13/14)	0/0/0/0/0
												Breast cancer screening (2010/11/12/13/14)		0/0/0/+/+
												Cervical cancer screening (2010/11/12/13/14)		0/0/0/+/+
												Colorectal cancer screening (2010/11/12/13/14)		0/0/0/+/+
												HPV vaccine (2010/11/12/13/14)	0/0/0/0/+
												Immunizations (combination 1) (2010/11/12/13/14)	+/0/+/0/+
												Meningococcal immunizations	+/0/+/0/+
												Td/Tdap immunizations	0/0/0/0/0
												HbA1c testing		0/0/0/0/0
												Medical attention for nephropathy		0/0/0/0/+
88	2021	Zhang	QN	USA	Commercial ACO	HMO, large independent practice association of physicians and hospital system	Global payment + shared savings	To	Enrolled members of commercial HMO	11,958 patients	20,275 patients	Generic drug use (2010/11/12/13/14)		0/0/0/0/0
												Generic drug spending (2010/11/12/13/14)			0/+/0/0/0
												Brand drug use (2010/11/12/13/14)		0/0/0/0/0
												Brand drug spending (2010/11/12/13/14)			0/0/0/0/0
												Total prescription drug use (2010/11/12/13/14)		0/0/+/+/0
												Total prescription drug spending (2010/11/12/13/14)			0/0/0/0/0
												Medication adherence (2010/11/12/13/14)	–/–/–/0/0
74	2020	Marrufo	QN	USA	ESRD Seamless Care Organization (ESCO)	Dialysis facilities, nephrologists, and other providers	Global payment + shared savings	To	Medicare fee-for-service beneficiaries	73,094 beneficiaries	60,464 beneficiaries	Radiation therapy use (180 days/30 days prior to death)		0/0			B1
												Chemotherapy use (180 days/30 days prior to death)		0/0
												Hospice use (180 days/30 days prior to death)		0/0
												ESRD hospitalization complications payment			+
												Total dialysis payment			–
												Hospitalizations		+
												Readmissions		0
												ED visits		0
												Emergency dialysis		0
												Dialysis sessions		+
												Catheter placement	+
												Vascular access complications	0

The Effect of Network-Level Payment Models on Care Network Performance: A Scoping Review of the Empirical Literature

Figures & Tables

Table 1

Figure 1

Table 2

Table 3

Table 4

Paradigm

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