Changes in spending, quality indicators, and provider experiences following the introduction of a population-based payment model in dutch primary care: a mixed methods evaluation

Background In July 2017, a Dutch health insurer and primary care organization jointly implemented the All-In Contract (AIC), a population-based payment model for general practitioners (GPs). Affiliated GP-practices received a capitated payment per enrolled patient covering all GP care and multidisciplinary primary care for chronic conditions. Additionally, the care organization shared in savings and losses on total healthcare spending, contingent upon meeting quality targets. This study investigates the AIC’s impact on spending, quality indicators, and provider experiences 2.5 years after implementation. Methods We employed a difference-in-differences approach comparing individual-level claims spending from enrollees of participating GP-practices (N = 16,425) with a control group (N = 212,251). Changes in indicators of chronic care management and patient satisfaction were investigated in a before-after analysis due to limited data availability. To contextualize the findings and explore provider experiences, focus groups were conducted with stakeholders involved in the development and/or implementation of the AIC. Results The AIC was associated with an insignificant 1.2% reduction of average quarterly total spending per enrollee (p = 0.476). We did find a − 10.2% decrease in primary care spending growth (p