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Published in: Journal of General Internal Medicine 5/2014

01-05-2014 | Perspective

Getting Value from Health Spending: Going Beyond Payment Reform

Authors: Sam Ho, MD, Lewis G. Sandy, MD

Published in: Journal of General Internal Medicine | Issue 5/2014

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Abstract

It is widely held that fee-for-service (FFS) payment systems reward volume and intensity of services, contributing to overall cost inflation, while doing little to reward quality, efficiency, or care coordination. Recently, The National Commission on Physician Payment Reform (sponsored by SGIM) has recommended that payers “should largely eliminate stand-alone fee-for-service payment to medical practices because of its inherent inefficiencies and problematic financial incentives.” As the current and former Chief Medical Officers of a large national insurer, we agree that payment reform is a critical component of health care modernization. But calls to transform payment simultaneously go too far, and don’t go far enough. Based on our experience, we believe there are several critical ingredients that are either missing or under-emphasized in most payment reform proposals, including: health care is local so no one size fits all; upgrading performance measures; monitoring/overcoming unintended consequences; using a full toolbox to achieve transformation; and ensuring that the necessary components for successful delivery reform are in place. Thinking holistically and remembering that healthcare is a complex adaptive system are crucial to achieving better results for patients and the health system.
Literature
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go back to reference Sandy LG, Tuckson RV, Stevens S. UnitedHealthcare experience illustrates how payers can enable patient engagement. Health Affairs 2013; 32(8):1440–5PubMedCrossRef Sandy LG, Tuckson RV, Stevens S. UnitedHealthcare experience illustrates how payers can enable patient engagement. Health Affairs 2013; 32(8):1440–5PubMedCrossRef
Metadata
Title
Getting Value from Health Spending: Going Beyond Payment Reform
Authors
Sam Ho, MD
Lewis G. Sandy, MD
Publication date
01-05-2014
Publisher
Springer US
Published in
Journal of General Internal Medicine / Issue 5/2014
Print ISSN: 0884-8734
Electronic ISSN: 1525-1497
DOI
https://doi.org/10.1007/s11606-013-2687-7

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