Outcomes incentives: can they catch on in the US?

As large scale implementation of the Affordable Care Act draws closer, physicians, payers, policy analysts, and other stakeholders expect the US healthcare system to shift towards payment models driven by outcomes rather than the volume of services rendered by providers. These newer models, say experts, better focus physicians on the patient’s wellbeing in the long run and ultimately can keep costs lower.

Several programs are in place already, among them the Bundled Payments Care Initiative implemented by the Centers for Medicare and Medicaid Services in January.1 2

But outcomes based payments currently make up a tiny fraction of payments made to doctors, according to a study released in June.3 Stakeholders are still struggling with determining exactly when quality based measures are appropriate and transforming a payment infrastructure wherein the fee for services model is so deeply entrenched.

Nevertheless, many physicians and policy experts suggest that implementing quality based measures will greatly benefit patients in the long run. Numerous payment methodologies can fall under the outcomes based rubric, among them bundled payments paying for specific episodes of care and patient capitation models paying for treatments associated with an individual.

“These sorts of models suggest that we should view the patient as the unit of analysis, not top line revenue,” said Doug Emery, program implementation leader for the western region, at Health Care Incentives Institute, Newtown, Connecticut, which advocates for payment reform.