Healthcare systems most often use three types of incentives: licensure requirements, social incentives, and financial incentives. Public health professionals can support HPV vaccine QI by implementing new incentives or enhancing and promoting existing ones.
Meeting licensure requirements
Most healthcare professionals are required to earn continuing education credits to maintain their licenses. Providing free or low-cost opportunities to do so can motivate healthcare providers to attend trainings and educational programs. Trainings and curriculums can be registered as continuing education credits through many professional organizations and universities. The American Academy of Family Physicians (AAFP) is one convenient, low-cost option.
Types of continuing education credits for health care providers
- Continuing Medical Education (CME) – needed by most physicians and some nurses
- Continuing Education (CE) and Continuing Nursing Education (CNE) – needed by most nurses
- Maintenance of Certification (MOC) – needed by physicians through 24 different medical specialty boards, including Pediatrics and Family Medicine
MOC Part 4 credits are often particularly valuable to providers. The American Board of Pediatrics requires pediatricians to earn 40 MOC Part 4 points every five years. MOC Part 4 credits are earned by participating in quality improvement activities. QI partners can help physicians earn MOC Part 4 credits by facilitating QI programs and providing templates for data and other types of required reporting.
One of the most common incentives is social recognition. Advantages are that these incentives are often relatively low cost and easy to facilitate.
Inexpensive or free types of social recognition:
- System- or clinic-wide announcements recognizing providers successful at meeting QI goals
- Awards like plaques and certificates that can be displayed in clinics
- Food rewards, such as lunch
- Gift cards for providers and staff
Other types of social recognition could include system-wide competitions for meeting QI goals, with a prize for the clinic that has the biggest improvement. Social recognition could come through a shared dashboard that allows providers to access individual vaccination rate data and compare it to others in their system or practice. This can encourage friendly competition. It also facilitates social recognition by giving system-wide visibility to providers who are doing a great job vaccinating their patients.
“[T]he other thing that we’re hoping to leverage with our dashboard is that we physicians also like to think that we’re all better than average even though that’s mathematically impossible. And so when you kind of see how you’re performing relative to your peers, there’s the sense of competition that sort of kicks in and that internal drive to be better than your peers.”Physician in a large healthcare system
Health systems are increasingly using financial incentives to motivate practice change. By understanding financial incentives, QI partners can encourage healthcare systems to prioritize high-value services, like HPV vaccination.
Financial incentives may go to individual healthcare providers or to the entire healthcare system. Physicians may get bonuses for meeting certain QI metrics, or less commonly, they may get a percentage of their salary withheld if they don’t meet goals. Healthcare systems also get financial incentives from external payers, like Medicaid and private insurers, for meeting certain national metrics, including HEDIS measures. Pharmaceutical companies will also give health systems discounts on vaccine orders for meeting vaccination goals. These system-level financial incentives often drive the choice of QI priorities.
“[T]he measures are designed to be easily achievable so that the real strength of those goals is physicians focusing on quality improvement, so probably 95 plus percent meet 100 percent of their goals so they don’t have any withhold and then there usually is a– there’s a small percentage bonus if you meet another particular goal that the system sets up for physicians which would be for inpatient and outpatient physicians.”Health system QI leader