Health care incentive model offers collaborativ...( A major focus in the search for acco...),Health

A major focus in the search for accountability in the U.S. health care system is new reimbursement and benefit models that provide incentives better linked to positive health outcomes. A recent study found some valuable lessons from a model in Maine that tied some degree of risk and reward for both health care providers and employer/purchasers.

The call of accountability in the U.S. health care system has spun off hospital report cards, reimbursement reforms and heightened expectations about the roles of patients and health care providers, in an attempt to address problems of healthcare access, quality and costs, said co-author Dennis Scanlon, associate professor of health policy and administration at Penn State.

While financial incentives seem obvious and techniques such as commissions and bonuses are used in other industries, the health care arena is really in the infancy of testing models of more rational payment, Scanlon adds.

Several high-profile programs include the CMS Premier Hospital pay-for-performance (P4P) demonstration, the IHA P4P initiative in California, the Bridges to Excellence program and the New York State Medicaid Health Plan incentive program. But like all efforts, each has advantages and disadvantages that are worth considering, says the Penn State researcher.

Many efforts have been developed by large insurance companies and have focused on performance measures based on various factors ranging from clinical and financial statistics to patient input, notes Scanlon.

Typical pay-for-performance (P4P) programs pay health care providers for meeting certain performance standards as an incentive reward. But a key question is the source of the reward dollars. Some analysts believe that health care providers also should put some of their compensation dollars at risk if they achieve low levels of performance on quality and efficiency measures.

The Maine Health Management Coalition comprises public and private emplo
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