--- title: "Financial MD and pt. incentives on lipid levels. | Sutter Health" description: "In primary care practices, shared financial incentives for physicians and patients, resulted in statistically significant but modest reduction in LDL-C levels." url: "https://www.sutterhealth.org/research/publications/financial-md-and-pt-incentives-on-lipid-levels-1055312784" --- 1. [Home](https://www.sutterhealth.org/) / 2. [Research](https://www.sutterhealth.org/research) / 3. [Research publications](https://www.sutterhealth.org/research/publications) / 4. Financial MD and pt. incentives on lipid levels. # Effect of financial incentives to physicians, patients, or both on lipid levels: a randomized clinical trial. Asch DA, Troxel AB, Stewart WF, Sequist TD, Jones JB, Hirsch AG, Hoffer K, Zhu J, Wang W, Hodlofski A, Frasch AB, Weiner MG, Finnerty DD, Rosenthal MB, Gangemi K, & Volpp KG. _JAMA. 314(18):1926-35. doi: 10.1001/jama.2015.14850._ 2015-11-10 ## Abstract IMPORTANCE: Financial incentives to physicians or patients are increasingly used, but their effectiveness is not well established. OBJECTIVE: To determine whether physician financial incentives, patient incentives, or shared physician and patient incentives are more effective than control in reducing levels of low-density lipoprotein cholesterol (LDL-C) among patients with high cardiovascular risk. DESIGN, SETTING, AND PARTICIPANTS: Four-group, multicenter, cluster randomized clinical trial with a 12-month intervention conducted from 2011 to 2014 in 3 primary care practices in the northeastern United States. Three hundred forty eligible primary care physicians (PCPs) were enrolled from a pool of 421. Of 25,627 potentially eligible patients of those PCPs, 1503 enrolled. Patients aged 18 to 80 years were eligible if they had a 10-year Framingham Risk Score (FRS) of 20% or greater, had coronary artery disease equivalents with LDL-C levels of 120 mg/dL or greater, or had an FRS of 10% to 20% with LDL-C levels of 140 mg/dL or greater. Investigators were blinded to study group, but participants were not. INTERVENTIONS: Primary care physicians were randomly assigned to control, physician incentives, patient incentives, or shared physician-patient incentives. Physicians in the physician incentives group were eligible to receive up to $1024 per enrolled patient meeting LDL-C goals. Patients in the patient incentives group were eligible for the same amount, distributed through daily lotteries tied to medication adherence. Physicians and patients in the shared incentives group shared these incentives. Physicians and patients in the control group received no incentives tied to outcomes, but all patient participants received up to $355 each for trial participation. MAIN OUTCOMES AND MEASURES: Change in LDL-C level at 12 months. RESULTS: Patients in the shared physician-patient incentives group achieved a mean reduction in LDL-C of 33.6 mg/dL (95% CI, 30.1-37.1; baseline, 160.1 mg/dL; 12 months, 126.4 mg/dL); those in physician incentives achieved a mean reduction of 27.9 mg/dL (95% CI, 24.9-31.0; baseline, 159.9 mg/dL; 12 months, 132.0 mg/dL); those in patient incentives achieved a mean reduction of 25.1 mg/dL (95% CI, 21.6-28.5; baseline, 160.6 mg/dL; 12 months, 135.5 mg/dL); and those in the control group achieved a mean reduction of 25.1 mg/dL (95% CI, 21.7-28.5; baseline, 161.5 mg/dL; 12 months, 136.4 mg/dL; P < .001 for comparison of all 4 groups). Only patients in the shared physician-patient incentives group achieved reductions in LDL-C levels statistically different from those in the control group (8.5 mg/dL; 95% CI, 3.8-13.3; P = .002). CONCLUSIONS AND RELEVANCE: In primary care practices, shared financial incentives for physicians and patients, but not incentives to physicians or patients alone, resulted in a statistically significant difference in reduction of LDL-C levels at 12 months. This reduction was modest, however, and further information is needed to understand whether this approach represents good value. [PubMed abstract](https://www.ncbi.nlm.nih.gov/pubmed/26547464) ![J.B. Jones, Ph.D., MBA](https://dyn.mktgcdn.com/p/rIQfkoa5XfKJYCHSVrDKsACQSNJ7jTljZTHKC4Lae2E/fit=crop,gravity=auto,dpr=2,width=188,height=250,quality=100) J.B. Jones, Ph.D., MBA Principal investigator [View profile](https://www.sutterhealth.org/research/investigators/jb-jones-phd-mba-1049680984) ## Research topics - [Cardiovascular Diseases](https://www.sutterhealth.org/research-search-results?query=%22%5C%22Cardiovascular+Diseases%5C%22%22) - [Disease Management](https://www.sutterhealth.org/research-search-results?query=%22%5C%22Disease+Management%5C%22%22) ## Related publications [View all publications](https://www.sutterhealth.org/research-search-results?verticalKey=research_publication) - Publication ### [High-resolution variable-density 3D cones coronary MRA.](https://www.sutterhealth.org/research/publications/high-resolution-vary-density-3d-cones-coronary-mra-1055312425) Addy NO, Ingle RR, Wu HH, Hu BS, Nishimura DG. Magn Reson Med. 74(3):614-21. doi: 10.1002/mrm.25803. Epub 2015 Jul 14. 2015 Sep 01 - Publication ### [Cardiovascular magnetic resonance phase contrast imaging.](https://www.sutterhealth.org/research/publications/cardiovasc-mri-phase-contrast-1055312458) Nayak KS, Nielsen JF, Bernstein MA, Markl M, D Gatehouse P, M Botnar R, Saloner D, Lorenz C, Wen H, S Hu B, Epstein FH, N Oshinski J, Raman SV. J Cardiovasc Magn Reson. 17(1):71. doi: 10.1186/s12968-015-0172-7. 2015 Aug 09 - Publication ### [Whole-heart coronary MR angiography using a 3D cones phyllotaxis trajectory.](https://www.sutterhealth.org/research/publications/whole-heart-coronary-mr-angiography-1055312405) Malavé MO, Baron CA, Addy NO, Cheng JY, Yang PC, Hu BS, Nishimura DG. Magn Reson Med. doi: 10.1002/mrm.27475. \[Epub ahead of print\] 2018 Oct 29 - Publication ### [Rapid single-breath-hold 3D late gadolinium enhancement cardiac MRI using a stack-of-spirals acquisition.](https://www.sutterhealth.org/research/publications/rapid-3d-gadolinium-enhancemt-cardiac-mri-1055312461) Shin T, Lustig M, Nishimura DG, Hu BS. J Magn Reson Imaging. 40(6):1496-502. doi: 10.1002/jmri.24494. Epub 2013 Nov 15. J Magn Reson Imaging. 40(6):1496-502. doi: 10.1002/jmri.24494. Epub 2013 Nov 15. Send to: 2014 Dec 02 - Publication ### [Nonrigid autofocus motion correction for coronary MR angiography with a 3D cones trajectory.](https://www.sutterhealth.org/research/publications/nonrigid-autofocus-motion-correctn-ht-mra-1055312469) Ingle RR, Wu HH, Addy NO, Cheng JY, Yang PC, Hu BS, Nishimura DG. Magn Reson Med. 72(2):347-61. doi: 10.1002/mrm.24924. Epub 2013 Sep 4. 2014 Aug 01 [View all publications](https://www.sutterhealth.org/research-search-results?verticalKey=research_publication) ```json {"@context":"https://schema.org","@type":"MedicalOrganization","name":"Sutter Health","@id":"https://www.sutterhealth.org/#medicalorganization","url":"https://www.sutterhealth.org","logo":"https://www.sutterhealth.org/static/images/sutter-health-logo.svg","address":{"@type":"PostalAddress","streetAddress":"2200 River Plaza Drive","addressLocality":"Sacramento","addressRegion":"CA","postalCode":"95833","addressCountry":"US"},"areaServed":{"@type":"AdministrativeArea","name":"California"},"sameAs":["https://www.facebook.com/SutterHealth","https://www.instagram.com/sutterhealth/","https://x.com/SutterHealth","https://www.youtube.com/sutterhealth","https://www.linkedin.com/company/sutter-health","https://en.wikipedia.org/wiki/Sutter_Health"]} ``` ```json {"@context":"https://schema.org","@type":"BreadcrumbList","@id":"https://www.sutterhealth.org/research/publications/financial-md-and-pt-incentives-on-lipid-levels-1055312784#breadcrumblist","itemListElement":[{"@type":"ListItem","position":1,"name":"Home","item":"https://www.sutterhealth.org/"},{"@type":"ListItem","position":2,"name":"Research","item":"https://www.sutterhealth.org/research"},{"@type":"ListItem","position":3,"name":"Research publications","item":"https://www.sutterhealth.org/research/publications"},{"@type":"ListItem","position":4,"name":"Financial MD and pt. incentives on lipid levels."}]} ``` ```json {"@context":"https://schema.org","@type":"MedicalScholarlyArticle","@id":"https://www.sutterhealth.org/research/publications/financial-md-and-pt-incentives-on-lipid-levels-1055312784#medicalscholarlyarticle","name":"Effect of financial incentives to physicians, patients, or both on lipid levels: a randomized clinical trial.","headline":"Financial MD and pt. incentives on lipid levels.","abstract":"IMPORTANCE: Financial incentives to physicians or patients are increasingly used, but their effectiveness is not well established. OBJECTIVE: To determine whether physician financial incentives, patient incentives, or shared physician and patient incentives are more effective than control in reducing levels of low-density lipoprotein cholesterol (LDL-C) among patients with high cardiovascular risk. DESIGN, SETTING, AND PARTICIPANTS: Four-group, multicenter, cluster randomized clinical trial with a 12-month intervention conducted from 2011 to 2014 in 3 primary care practices in the northeastern United States. Three hundred forty eligible primary care physicians (PCPs) were enrolled from a pool of 421. Of 25,627 potentially eligible patients of those PCPs, 1503 enrolled. Patients aged 18 to 80 years were eligible if they had a 10-year Framingham Risk Score (FRS) of 20% or greater, had coronary artery disease equivalents with LDL-C levels of 120 mg/dL or greater, or had an FRS of 10% to 20% with LDL-C levels of 140 mg/dL or greater. Investigators were blinded to study group, but participants were not. INTERVENTIONS: Primary care physicians were randomly assigned to control, physician incentives, patient incentives, or shared physician-patient incentives. Physicians in the physician incentives group were eligible to receive up to $1024 per enrolled patient meeting LDL-C goals. Patients in the patient incentives group were eligible for the same amount, distributed through daily lotteries tied to medication adherence. Physicians and patients in the shared incentives group shared these incentives. Physicians and patients in the control group received no incentives tied to outcomes, but all patient participants received up to $355 each for trial participation. MAIN OUTCOMES AND MEASURES: Change in LDL-C level at 12 months. RESULTS: Patients in the shared physician-patient incentives group achieved a mean reduction in LDL-C of 33.6 mg/dL (95% CI, 30.1-37.1; baseline, 160.1 mg/dL; 12 months, 126.4 mg/dL); those in physician incentives achieved a mean reduction of 27.9 mg/dL (95% CI, 24.9-31.0; baseline, 159.9 mg/dL; 12 months, 132.0 mg/dL); those in patient incentives achieved a mean reduction of 25.1 mg/dL (95% CI, 21.6-28.5; baseline, 160.6 mg/dL; 12 months, 135.5 mg/dL); and those in the control group achieved a mean reduction of 25.1 mg/dL (95% CI, 21.7-28.5; baseline, 161.5 mg/dL; 12 months, 136.4 mg/dL; P \u003c .001 for comparison of all 4 groups). Only patients in the shared physician-patient incentives group achieved reductions in LDL-C levels statistically different from those in the control group (8.5 mg/dL; 95% CI, 3.8-13.3; P = .002). CONCLUSIONS AND RELEVANCE: In primary care practices, shared financial incentives for physicians and patients, but not incentives to physicians or patients alone, resulted in a statistically significant difference in reduction of LDL-C levels at 12 months. This reduction was modest, however, and further information is needed to understand whether this approach represents good value.","description":"In primary care practices, shared financial incentives for physicians and patients, resulted in statistically significant but modest reduction in LDL-C levels.","keywords":["Cardiovascular Diseases","Disease Management"],"datePublished":"2015-11-10","url":"https://www.sutterhealth.org/research/publications/financial-md-and-pt-incentives-on-lipid-levels-1055312784","inLanguage":"en-US","identifier":[{"@type":"PropertyValue","propertyID":"PMID","value":"26547464"},{"@type":"PropertyValue","propertyID":"DOI","value":"10.1001/jama.2015.14850"}],"sameAs":["https://pubmed.ncbi.nlm.nih.gov/26547464/","https://doi.org/10.1001/jama.2015.14850"],"isPartOf":{"@type":"Periodical","name":"JAMA"},"author":[{"@type":"Person","name":"Asch DA"},{"@type":"Person","name":"Troxel AB"},{"@type":"Person","name":"Stewart WF"},{"@type":"Person","name":"Sequist TD"},{"@type":"Person","@id":"https://www.sutterhealth.org/research/investigators/jb-jones-phd-mba-1049680984","name":"Jones JB","url":"https://www.sutterhealth.org/research/investigators/jb-jones-phd-mba-1049680984"},{"@type":"Person","name":"Hirsch AG"},{"@type":"Person","name":"Hoffer K"},{"@type":"Person","name":"Zhu J"},{"@type":"Person","name":"Wang W"},{"@type":"Person","name":"Hodlofski A"},{"@type":"Person","name":"Frasch AB"},{"@type":"Person","name":"Weiner MG"},{"@type":"Person","name":"Finnerty DD"},{"@type":"Person","name":"Rosenthal MB"},{"@type":"Person","name":"Gangemi K"},{"@type":"Person","name":"Volpp KG"}],"sourceOrganization":{"@type":"MedicalOrganization","name":"Palo Alto Medical Foundation Research Institute"},"about":[{"@type":"DefinedTerm","name":"Cardiovascular Diseases","url":"https://www.sutterhealth.org/research-search-results?facets=%5B%7B%22i%22%3A%22c_researchTopics.name%22%2C%22v%22%3A%5B%22Cardiovascular+Diseases%22%5D%7D%5D&verticalKey=research_publication"},{"@type":"DefinedTerm","name":"Disease Management","url":"https://www.sutterhealth.org/research-search-results?facets=%5B%7B%22i%22%3A%22c_researchTopics.name%22%2C%22v%22%3A%5B%22Disease+Management%22%5D%7D%5D&verticalKey=research_publication"}],"mainEntityOfPage":{"@type":"WebPage","@id":"https://www.sutterhealth.org/research/publications/financial-md-and-pt-incentives-on-lipid-levels-1055312784","breadcrumb":{"@id":"https://www.sutterhealth.org/research/publications/financial-md-and-pt-incentives-on-lipid-levels-1055312784#breadcrumblist"}}} ```