Aligning provider incentives to improve primary health care delivery in the United States

Abstract

Background-The United States (US) is reforming primary care delivery systems, including the implementation of 'patient-centered medical homes.' Alignment of provider incentives with desired outcomes will likely be important to the success of these delivery system reforms.

Evaluation of an Intervention to Reduce Low-Value Preoperative Care for Patients Undergoing Cataract Surgery at a Safety-Net Health System

“…Previous initiatives to reduce low-value testing for cataract surgery have yielded, at best, modest results . Because health systems typically receive more revenue when they deliver more care, policy experts often implicate perverse financial incentives as the primary driver of unnecessary care . However, even at capitated health systems, such as the Los Angeles County Department of Health Services (LAC-DHS), one of the largest safety-net health systems in the United States, more than 90% of patients continue to receive low-value preoperative testing for cataract surgery.…”

“…21 Because health systems typically receive more revenue when they deliver more care, policy experts often implicate perverse financial incentives as the primary driver of unnecessary care. 22 However, even at capitated health systems, such as the Los Angeles County Department of Health Services (LAC-DHS), one of the largest safety-net health systems in the United States, more than 90% of patients continue to receive low-value preoperative testing for cataract surgery. Such examples suggest that factors beyond finances contribute to the persistence of low-value preoperative testing, such as lack of knowledge, habit, and non-evidence-based protocols.…”

"A Paradox Persists When the Paradigm Is Wrong": Pisacano Scholars' Reflections from the Inaugural Starfield Summit

“…This trajectory inhibits the improvement of primary care and the financial sustainability of the health care system. 11,17 Despite inherent problems in the fee-for-service model, it can be valuable if restructured to place higher fees on services that support improvement in overall health outcomes rather than individual disease states and when used for low-cost and underutilized services such as vaccines. 11 Alternative models that incorporate different payment schemes are being implemented across the country.…”