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Aligning fiscal incentives aimed at providers and patients


Suzanne Delbanco and  Roslyn Murray, writing in Health Affairs, discuss  the potential advantages of aligning high-value benefit designs for patients with payment reform.

Among their observations:

“While payment reform efforts are proliferating, we still have a lot to learn about which health care payment and delivery reform programs result in more affordable care, with better outcomes for patients. But one thing we see often is a mismatch between the incentives offered to health care providers and those offered to their patients, who may not be driven to seek care from practices that have restructured to provide higher value care.

“This disconnect causes difficulties for providers who spend time and money restructuring to improve patient care, sometimes at financial risk. To succeed under payment reforms, providers often need patient volume, which may only materialize if those shaping health plan offerings design programs that thoughtfully interweave the right benefit and network designs.”

“The CareFirst PCMH Program {in Maryland} provides an example of how aligning patient incentives with those of health care providers could produce better, more affordable care. Although the Program’s early results are mixed, it may produce greater costs-savings as consumers become more aware of their financial incentives to seek care from less expensive sites or from lower-cost, higher-quality providers (due to out-of-pocket differentials). Providers and patients may be more successful in lowering the use of unnecessary services and procedures and increasing utilization of needed care if they work toward the same goal.”

To read the article, please hit this link.

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