DiabetesNCT02731716
Transforming Primary Care Payment in Hawaii
A study testing New Payment Model, Social Comparisons and A1c Member/Provider Incentive in people with Diabetes, run by University of Pennsylvania.
Trial summary
To design an innovative payment system that improves upon fee-for-service (FFS), incorporates behavioral economic principles, and improves work satisfaction among primary care physicians (PCPs) while improving quality and reducing health spending at the state level. Read more about this study
- Who is it for?
- Ages 18 years and older
- Conditions the study is for
- Diabetes
- What is being tested?
- New Payment Model, Social Comparisons and A1c Member/Provider Incentive
- Type of treatment
- Lifestyle or therapy programme
- Could I receive a placebo?
- No, everyone receives an active treatment
- How many people
- 117 participants
- Where
- No sites listed yet
- Study dates
- Apr 2016to Jul 2027
- Phase
- Interventional
- Are there results?
- Not yet: the study is under way
Key requirements
Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.
- Ages 18 years and older
- All sexes
- No healthy volunteers
- Adult, Older adult
Who may be able to join
- HMSA physicians who are part of a Provider Organization that is participating in the payment transformation pilot.
Who cannot join
- Any physician who is not part of a participating Provider Organization.
About this study
To design an innovative payment system that improves upon fee-for-service (FFS), incorporates behavioral economic principles, and improves work satisfaction among primary care physicians (PCPs) while improving quality and reducing health spending at the state level. Second, to test the incremental effectiveness of two additional interventions: (1) shared financial incentives between physicians and poorly controlled diabetes and (2) social comparisons ranking physicians on quality metric performance and total cost of care.
Read the detailed description
The goal of this project is to transform the Hawaii Medical Service Association (HMSA) primary care provider payment model to better incentive population health while bending the increasing trend of health spending in the state. Primary care and overall spending patterns will be studied to lay the foundation for a more rationally designed model. This model deliberately shifts away from FFS and includes three components: 1) a risk-adjusted per-member, per-month (PMPM) base payment, 2) an enhanced quality incentive program with larger bonus amounts and 3) a total cost of care incentive at the PO level. The aim is to build on the success of the Alternative Quality Contract (AQC) program implemented by Blue Cross Blue Shield (BCBS) of Massachusetts. While the AQC is used as a starting point, the study introduces and tests a number of innovations using concepts from behavioral economics. First, the move away from the FFS chassis to a PMPM-based capitated payment. Second, 20% of the PMPM payment is at-risk based on metrics designed to increase engagement between HMSA and physicians and engagement with performance feedback. Third, the number of metrics in the quality incentive program is drastically reduced from over 60 metrics to 10-12 per specialty. Fourth, the scoring of quality incentives incorporates rewards for improvement, rather than exclusively attainment of thresholds, to activate physicians along the entire performance distribution. In addition to implementing the new payment model, the initial experiment will include a test of two additional behavioral concepts: social comparisons for physicians and a shared incentive for physicians and poorly controlled diabetics tied to improve glycemic control.
- Conditions
- Diabetes
- Being tested
- New Payment Model, Social Comparisons, A1c Member/Provider Incentive
- Medical subject headings
- Diabetes Mellitus
What participants receive
What participants receive. In a randomised study each person is assigned to one group by chance.
New Payment ModelBehavioural
Providers will no longer be paid based upon FFS, but on the new payment model, which includes PMPM and quality incentives.
Social ComparisonsBehavioural
Providers will receive weekly emails showing comparisons in quality metrics and total cost of care. They will be compared to other providers in their provider organization.
A1c Member/Provider IncentiveBehavioural
Attributed members and their PCPs will receive up to $75 for a reduction of a1c by 0.5% per quarter (2 quarters).
| Study group | Role | What they receive |
|---|---|---|
| New Payment Model | Experimental | Providers in the first arm will no longer be paid based upon FFS, but on the new payment model. Providers will receive a PMPM payment for attributed members, a quality incentive payment based upon attainment of sixteen quality metrics, and a possible bonus payment for savings in total cost of care at the provider organization level. Receives: Behavioral: New Payment Model |
| Social Comparisons | Experimental | Providers will no longer be paid based upon FFS, but on the new payment model. Providers will receive a PMPM payment for attributed members, a quality incentive payment based upon attainment of sixteen quality metrics, and a possible bonus payment for savings in total cost of care at the provider organization level. Providers will also receive weekly emails that will show comparisons of their own performance against their peers within the same provider organization on specific quality measures and total cost of care. Receives: Behavioral: New Payment Model; Behavioral: Social Comparisons |
| A1c Member/Provider Incentive | Experimental | Providers will no longer be paid based upon FFS, but on the new payment model, which includes a PMPM payment for attributed members, a quality incentive payment based upon attainment of quality metrics, and a possible bonus payment for savings in total cost of care. Providers will also receive weekly emails that will show comparisons of their own performance against their peers within the same provider organization on specific quality measures and total cost of care. There is also a shared incentive between the member and the provider. The member incentive will be a payment made to diabetic patients with an A1C of greater than or equal to 9% who experience a reduction of at least 0.5%. Each participating member and PCP can receive up to $75 per quarter for A1C reduction. Receives: Behavioral: New Payment Model; Behavioral: Social Comparisons; Behavioral: A1c Member/Provider Incentive |
What is being measured
The primary outcome is the main question the study is designed to answer.
Improvement in Provider Performance
Provider performance on quality metrics will be compared across all three arms.
Measured: 1 year
Secondary outcomes (2)
Improvement in A1C among poorly controlled diabetics
A1c levels will be compared across all three arms to see if there is a reduction in a1c in arm 3.
Measured: 6 Months
Primary Care Spending
Primary care spending in primary care providers will be compared across all three arms.
Measured: 1 year
Timeline
From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.
- First posted7 Apr 2016 (estimated)
- Study startApr 2016
- Primary completionDec 2017
- Study completionJul 2027 (estimated)
Resources
- Official record on ClinicalTrials.govThe registry entry this page is built from, with its full change history.
- Other trials for DiabetesStudies of the same condition, open and under way.
- More trials run by University of PennsylvaniaThe sponsor's other registered studies.
- What the trial phases meanHow a treatment moves from first tests in people to approval.
More details
For doctors and researchers: how the study is designed, who runs it, and its registry IDs.
Study design
- Study type
- Interventional
- Phase
- Phase N/A
- Primary purpose
- Health services research
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Masking
- None (open label)
- Enrolment
- 117 participants (actual)
Sponsor and investigators
- Lead sponsor
- University of Pennsylvania
- Sponsor type
- University, hospital or other
- Collaborators
- Hawaii Medical Service Association
- Responsible party
- Principal investigator, Amol Navathe, University of Pennsylvania
IDs, dates and publications
- ClinicalTrials.gov ID
- NCT02731716
- Sponsor's protocol ID
- 823981
- Status last verified
- Aug 2025
- First submitted
- 28 Mar 2016
- Last updated
- 26 Aug 2026
- Results posted
- No
- Data monitoring committee
- No
- Individual data sharing
- No
Study at a glance
From the registry record, last updated by the sponsor on 26 Aug 2026. Recruitment status is as the sponsor reported it: confirm with the study team.
- Official title
- Transforming Primary Care Payment in Hawaii
- ClinicalTrials.gov ID
- NCT02731716
- Acronym / sponsor ID
- 823981
- Conditions
- Diabetes
- Study type
- Interventional
- Recruitment status
- Active, not recruiting
- Enrolment
- 117 participants (actual)
- Lead sponsor
- University of PennsylvaniaUniversity, hospital or other
- Collaborators
- Hawaii Medical Service Association
- Study start
- Apr 2016
- Primary completion
- Dec 2017 (actual)
- Study completion
- Jul 2027 (estimated)
- First posted
- 7 Apr 2016 (estimated)
- Results
- Not posted in the source record
Clinical summary
The research question as the sponsor registered it. This describes what the study plans to test, not what it found.
To design an innovative payment system that improves upon fee-for-service (FFS), incorporates behavioral economic principles, and improves work satisfaction among primary care physicians (PCPs) while improving quality and reducing health spending at the state level. Second, to test the incremental effectiveness of two additional interventions: (1) shared financial incentives between physicians and poorly controlled diabetes and (2) social comparisons ranking physicians on quality metric performance and total cost of care.
Detailed description
The goal of this project is to transform the Hawaii Medical Service Association (HMSA) primary care provider payment model to better incentive population health while bending the increasing trend of health spending in the state. Primary care and overall spending patterns will be studied to lay the foundation for a more rationally designed model. This model deliberately shifts away from FFS and includes three components: 1) a risk-adjusted per-member, per-month (PMPM) base payment, 2) an enhanced quality incentive program with larger bonus amounts and 3) a total cost of care incentive at the PO level. The aim is to build on the success of the Alternative Quality Contract (AQC) program implemented by Blue Cross Blue Shield (BCBS) of Massachusetts. While the AQC is used as a starting point, the study introduces and tests a number of innovations using concepts from behavioral economics. First, the move away from the FFS chassis to a PMPM-based capitated payment. Second, 20% of the PMPM payment is at-risk based on metrics designed to increase engagement between HMSA and physicians and engagement with performance feedback. Third, the number of metrics in the quality incentive program is drastically reduced from over 60 metrics to 10-12 per specialty. Fourth, the scoring of quality incentives incorporates rewards for improvement, rather than exclusively attainment of thresholds, to activate physicians along the entire performance distribution. In addition to implementing the new payment model, the initial experiment will include a test of two additional behavioral concepts: social comparisons for physicians and a shared incentive for physicians and poorly controlled diabetics tied to improve glycemic control.
Study design
- Primary purpose
- Health services research
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Masking
- None (open label)
- Number of arms
- 3
| Arm | Type | Receives |
|---|---|---|
| New Payment Model | Experimental | Behavioral: New Payment ModelProviders in the first arm will no longer be paid based upon FFS, but on the new payment model. Providers will receive a PMPM payment for attributed members, a quality incentive payment based upon attainment of sixteen quality metrics, and a possible bonus payment for savings in total cost of care at the provider organization level. |
| Social Comparisons | Experimental | Behavioral: New Payment Model, Behavioral: Social ComparisonsProviders will no longer be paid based upon FFS, but on the new payment model. Providers will receive a PMPM payment for attributed members, a quality incentive payment based upon attainment of sixteen quality metrics, and a possible bonus payment for savings in total cost of care at the provider organization level. Providers will also receive weekly emails that will show comparisons of their own performance against their peers within the same provider organization on specific quality measures and total cost of care. |
| A1c Member/Provider Incentive | Experimental | Behavioral: New Payment Model, Behavioral: Social Comparisons, Behavioral: A1c Member/Provider IncentiveProviders will no longer be paid based upon FFS, but on the new payment model, which includes a PMPM payment for attributed members, a quality incentive payment based upon attainment of quality metrics, and a possible bonus payment for savings in total cost of care. Providers will also receive weekly emails that will show comparisons of their own performance against their peers within the same provider organization on specific quality measures and total cost of care. There is also a shared incentive between the member and the provider. The member incentive will be a payment made to diabetic patients with an A1C of greater than or equal to 9% who experience a reduction of at least 0.5%. Each participating member and PCP can receive up to $75 per quarter for A1C reduction. |
Who may qualify
- Ages
- 18 years and older
- Sex
- All
- Healthy volunteers
- Not accepted
- Age groups
- Adult, Older adult
Key inclusion criteria (1 listed)
- HMSA physicians who are part of a Provider Organization that is participating in the payment transformation pilot.
Key exclusion criteria (1 listed)
- Any physician who is not part of a participating Provider Organization.
Eligibility is decided by the study team after screening; this overview does not establish that a patient qualifies. Full inclusion and exclusion criteria.
Interventions
| Intervention | Type | Arms |
|---|---|---|
| New Payment ModelProviders will no longer be paid based upon FFS, but on the new payment model, which includes PMPM and quality incentives. | Behavioural | A1c Member/Provider Incentive, New Payment Model, Social Comparisons |
| Social ComparisonsProviders will receive weekly emails showing comparisons in quality metrics and total cost of care. They will be compared to other providers in their provider organization. | Behavioural | A1c Member/Provider Incentive, Social Comparisons |
| A1c Member/Provider IncentiveAttributed members and their PCPs will receive up to $75 for a reduction of a1c by 0.5% per quarter (2 quarters). | Behavioural | A1c Member/Provider Incentive |
Primary outcome
Improvement in Provider Performance
Time frame: 1 year
Provider performance on quality metrics will be compared across all three arms.
2 secondary outcomes
Improvement in A1C among poorly controlled diabetics
Time frame: 6 Months
Primary Care Spending
Time frame: 1 year
Results and safety
This study is still under way. Results are not available in the source record yet.
Research links
- Official record on ClinicalTrials.govLast updated by the sponsor 26 Aug 2026.
- Individual participant dataSharing planned: No
Related trials for Diabetes
Recruiting
Using Ultromics EchoGo HFpEF Algorithm to Identify and Treat High Heart Failure Risk in Patients With Type 2 Diabetes
Heart Failure, Diabetes
Not yet recruiting
STRONG: SMART Trial
Gestational Diabetes Mellitus (GDM)
Recruiting
Continuous Glucose Monitoring Systems in People With Type 2 Diabetes Not Treated With Insulin
Type 2 Diabetes
Active, not recruitingPhase 4
Pentoxifylline in Diabetic Kidney Disease
Diabetic Kidney Disease
Not yet recruiting
Inter-Arm Differences in Continuous Glucose Monitor Readings in Adults With Diabetes
Continuous Glucose Monitoring, Type 1 Diabetes
Referral and contact
AzTrials does not enrol participants or take referrals. Contact the study team or a site listed below; they decide who can take part. This study is not recruiting at the moment.
The record lists no contact. Use the official record to reach the sponsor.
Questions about this trial
What is this clinical trial studying?
A study testing New Payment Model, Social Comparisons and A1c Member/Provider Incentive in people with Diabetes, run by University of Pennsylvania.
The full registered description is in the About this study section and the official record.
Who may be eligible to take part?
The sponsor lists 1 inclusion and 1 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.
Is this clinical trial currently recruiting?
The record says: under way, not looking for participants, as of the sponsor's last update on 26 Aug 2026. Status can change between updates, so confirm with the study contact before making plans.
What are the possible benefits and risks?
They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.
Are results available for this study?
This study is still under way. Results are not available in the source record yet.
How can a doctor refer a patient or contact the research team?
The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.
What does the primary outcome measure?
Improvement in Provider Performance (time frame: 1 year). It is what the study was designed to measure, not a finding.
Where can I read the original study information?
Does a listing mean the treatment is approved or proven to work?
No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.
How often is this information updated?
AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 26 Aug 2026.