Thursday, September 3, 2009

Performance Contracts in Health Care

This story by NPR's "Morning Edition" is about a novel contracting form between a health insurance company and a health care provider. Traditional "fee for service," encourages more services, many of which may be unnecessary, and an under-provision of preventative care and counseling, because it is difficult to contract over something you cannot effectively measure. Instead, this experiment pays for performance measures, such as actual health outcomes and decreased need for future procedures. The firms have innovated on the contract form in order to create value to the insurance company, the provider, and ultimately the patient.

I do not know if NPR included this near the end as a dig at health care reformers.
It's kind of interesting that Washington is reforming health care, when they're not the ones in the room with the patient, and that's really what this project is about: letting the people in the room with the patient reform health care.

Under this new model, we're accountable ...

1 comment:

  1. So with this plan, physicians are reimbursed better (per patient) for seeing fewer patients and for diagnosis problems later or not at all.(If there is no diagnosis, I assume that the pt. will be considered to be healthy and reimbursement would be better?).

    Sure giving medicine for diabetes will delay complications, but will they not just occur next year or the year after, especially if the patient continues the same unhealthy habits that contributed to diabetes? Ultimately, will the provider still bear responsibility? It would be better if the pt. would lose weight and exercise and not have diabetes at all. I have trouble imagining that providers spending an extra 30 minutes with the patient, will make the patient decide to push back from the dinner table and start exercising.

    Based on the potential for delay of complicatins from chronic medical problems (heart and lung disease, diabetes, etc.) I would say that the first 5-10 years under this plan may look pretty good, but after that it will be a wash.