Performance-based risk-sharing agreements in renal care: current experience and future prospects

Abstract

Introduction:Performance-based risk-sharing agreements (PBRSAs), between payers, health care providers, and technology manufacturers can be useful when there is uncertainty about the (cost-) effectiveness of a new technology or service. However, they can be challenging to design and implement. Areas covered: A total of 18 performance-based agreements were identified through a literature review. All but two of the agreements identified were pay-for-performance schemes, agreed between providers and payers at the national level. No examples were found of agreements between health care providers and manufacturers at the local level. The potential for these local agreements was illustrated by hypothetical case studies of water quality management and an integrated chronic kidney disease program. Expert opinion: Performance-based risk-sharing agreements can work to the advantage of patients, health care providers, payers, and technology manufacturers, particularly if they facilitate the introduction of technologies or systems of care that might not have been introduced otherwise. However, the design, conduct, and implementation of PBRSAs in renal care pose a number of challenges. Efforts should be made to overcome these challenges so that more renal care patients can benefit from technological advances and new models of care.

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“…Longevity means increased burden of care, but this could partially be compensated by incentivizing general well‐being (reduced morbidity) so that a patient is able to lead as normal a life as possible and contribute to society 62 . However, every hospitalization means significant extra costs for the payer (healthcare system), depending on the severity of the incidence and duration of stay, planned or unplanned.…”

“…Longevity means increased burden of care, but this could partially be compensated by incentivizing general well-being (reduced morbidity) so that a patient is able to lead as normal a life as possible and contribute to society. 62 However, every hospitalization means significant extra costs for the payer (healthcare system), depending on the severity of the incidence and duration of stay, planned or unplanned. During the hospitalization period, HD therapy must nevertheless be continued at the prescribed intervals and even may be more if the patient's volume status is impacted and/or if they are more catabolic.…”