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The American Journal of Managed Care August 2015
Differential Impact of Mental Health Multimorbidity on Healthcare Costs in Diabetes
Leonard E. Egede, MD, MS; Mulugeta Gebregziabher, PhD; Yumin Zhao, PhD; Clara E. Dismuke, PhD; Rebekah J. Walker, PhD; Kelly J. Hunt, PhD, MSPH; and R. Neal Axon, MD, MSCR
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Kristin N. Ray, MD, MS; Amalavoyal V. Chari, PhD; John Engberg, PhD; Marnie Bertolet, PhD; and Ateev Mehrotra, MD, MPH
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Bruce E. Landon, MD, MBA, MSc; Alan M. Zaslavsky, PhD; Robert Saunders, PhD; L. Gregory Pawlson, MD, MPH; Joseph P. Newhouse, PhD; and John Z. Ayanian, MD, MPP
Medicare Shared Savings Program: Public Reporting and Shared Savings Distributions
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Currently Reading
Global Payment Contract Attitudes and Comprehension Among Internal Medicine Physicians
Joshua Allen-Dicker, MD, MPH; Shoshana J. Herzig, MD, MPH; and Russell Kerbel, MD, MBA
The Association Among Medical Home Readiness, Quality, and Care of Vulnerable Patients
Lena M. Chen, MD, MS; Joseph W. Sakshaug, PhD; David C. Miller, MD, MPH; Ann-Marie Rosland, MD, MS; and John Hollingsworth, MD, MS
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Jessica S. Ancker, MPH, PhD; Samantha Brenner, MD; Joshua E. Richardson, PhD, MLIS, MS; Michael Silver, MS; and Rainu Kaushal, MD, MPH
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James D. Slover, MD, MS; Raj J. Karia, MPH; Chelsie Hauer, MPH; Zachary Gelber, DDS; Philip A. Band, PhD; and Jove Graham, PhD
A Randomized Controlled Trial of Co-Payment Elimination: The CHORD Trial
Kevin G. Volpp, MD, PhD; Andrea B. Troxel, ScD; Judith A. Long, MD; Said A. Ibrahim, MD, MPH; Dina Appleby, MS; J. Otis Smith, EdD; Jane Jaskowiak, BSN, RN; Marie Helweg-Larsen, PhD; Jalpa A. Doshi, PhD; and Stephen E. Kimmel, MD, MSCE
A Randomized Controlled Trial of Negative Co-Payments: The CHORD Trial
Kevin G. Volpp, MD, PhD; Andrea B. Troxel, ScD; Judith A. Long, MD; Said A. Ibrahim, MD, MPH; Dina Appleby, MS; J. Otis Smith, EdD; Jalpa A. Doshi, PhD; Jane Jaskowiak, BSN, RN; Marie Helweg-Larsen, PhD; and Stephen E. Kimmel, MD, MSCE

Global Payment Contract Attitudes and Comprehension Among Internal Medicine Physicians

Joshua Allen-Dicker, MD, MPH; Shoshana J. Herzig, MD, MPH; and Russell Kerbel, MD, MBA
Four years following engagement by an urban care organization in global payment contracts, a majority of internal medicine physicians there were supportive of this action.
RESULTS
Internist Demographics

Of the 569 Department of Medicine physicians contacted, 281 (49.4%) completed our survey (Table 1). Of all respondents, 52% identified themselves as general medicine physicians, while 48% identified themselves as specialist physicians. Respondents were representative of the total survey population with respect to the proportion of generalists (52% vs 47.4%; P = .22). Forty-two percent of respondents had completed their residency training more than 20 years prior, and 150 physicians (53.4%) reported spending more than half their time working on a clinical service.
Two hundred and thirty-one (82.3%) respondents reported being previously exposed to educational information sources on GPCs. The most common sources of information were informal discussions with other healthcare providers, news media, and academic journals (eAppendix B).
 
Internist Comprehension
Median score on the knowledge portion of the survey was 70% (25th quartile = 60%; 75th quartile = 80%; mean = 66.2%; SD = 13.7). Physicians who scored equal to or greater than the 50th percentile were significantly more likely to report previously consulting any educational source about GPCs than those who scored below the 50th percentile (58.4% vs 41.6%; P <.001).
 
Physician Attitudes
Two hundred and thirty-eight (84.7%) respondents reported agreeing or strongly agreeing with the care organization’s decision to enter into GPCs. Of those, 219 respondents (92%) selected at least 1 of the predefined reasons for this decision. Each respondent selected an average of 2.9 predefined reasons (25th quartile, 1 response; 75th quartile, 4 responses) The most popular reasons were a) perceived reduction in the cost of patient care and b) perceived increased competitiveness in the healthcare market (Table 2a). The least common reason was perceived personal financial benefit.
 
Of those who disagreed or strongly disagreed with the decision to enter into GPCs, 39 respondents (90.7%) selected at least 1 of the predefined options. Each respondent selected an average of 3.7 predefined responses (25th quartile = 2 responses; 75th quartile = 5 responses). The most popular reasons were a) perceived failure to improve the quality of patient health and b) failure to improve the quality of the physician experience (Table 2b). The least common reason was perceived failure to improve competitiveness in the healthcare market.
 
Associations Between Physician Characteristics and Level of GPC Support
See Table 1 for bivariable and multivariable associations between physician characteristics and level of GPC support. In our multivariate ordinal logistic regression model, variables independently associated with higher likelihood of supporting involvement in GPCs included scoring at or above the 50th percentile in the knowledge assessment (P = .01); reporting prior exposure to informational sources about GPCs (P = .01); working less than or equal to 50% clinical full-time equivalents (<.001); and completion of residency more than 20 years ago (<.01). There was no association between status as a generalist versus a specialist and likelihood of support for GPC involvement.
 


 
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