Learning from the implementation phase of the new French capitation payment model for chronic kidney disease care: a qualitative study.

Abstract

Background: France introduced a new payment model for care providers of patients with Chronic Kidney Disease (CKD) Grades 4 and 5: the CKD-Capitation Payment model. The model aims to financially incentivise multidisciplinary care for patients. We performed a qualitative study among participating providers to identify obstacles and facilitators of the model implementation as well as the initial benefits and potential policy improvements.

Methods: From March to July 2023, we collected data through semi-structured interviews with medical and managerial staff of facilities participating in the new model in France. We purposely selected a sample of facilities based on ownership status and CKD-Capitation Payment model activity data, including the number of patients reported. We performed a thematic analysis of the interview transcripts.

Results: We interviewed 22 staff from 14 facilities. Interviews revealed that adapting the information systems to the model requirements was a major obstacle to implementation, undermining efficient medical time allocation and data quality. Securing facility management support and organising the care amid workforce shortages were additional obstacles. Despite these challenges, staff reported positively on the model, noting the increased time spent by nurses with patients and the assertion of dietitians' role. Interviewees reported the need for greater flexibility in visit requirements to better align with patient needs.

Conclusions: This study demonstrates how the new capitation payment model introduced in France can enable multidisciplinary and coordinated care for patients with CKD. However, supporting facilities in adopting interoperable information systems and increasing the flexibility of the model appear essential for long-term adoption.