Rewarding Healthy Behaviors--Pay Patients for Performance

Abstract

Despite a considerable investment of resources into pay for performance, preliminary studies have found that it may not be signifi cantly more effective in improving health outcome measures when compared with voluntary quality improvement programs. Because patient behaviors ultimately affect health outcomes, I would propose a novel pay-for-performance program that rewards patients directly for achieving evidence-based health goals. These rewards would be in the form of discounts towards co-payments for doctor's visits, procedures, and medications, thereby potentially reducing cost and compliance issues. A pilot study recruiting patients with diabetes or hypertension, diseases with clear and objective outcome measures, would be useful to examine true costs, savings, and health outcomes of such a reward program. Offering incentives to patients for reaching health goals has the potential to foster a stronger partnership between doctors and patients and improve health outcomes. INTRODUCTION In an effort to improve health care quality, insurance companies and Medicare initiated pay-for-performance (P4P) programs that reward health care clinicians for achieving certain evidence-based performance measures. In theory, it seems as though this system should help improve patient health. Yet, a recent study of 500,000 patients in the United Kingdom found that P4P did not result in better hypertension outcomes over a 7-year period, despite input of $2.8 billion from the government.1 In the United States, studies have also shown mostly negative results, and concerns have arisen concerning deselection of complicated or low-income patients. 2-5Why might P4P fail? There are many potential factors, but one major cause is the complexity of effecting behavior change. P4P tries to improve health care based on the assumption that a single physician can successfully change the health-related behaviors of 1,000 patients. Indeed, physician counseling can help prime a patient for change, 6 but ultimately it is the patient's behavior change that will directly affect health outcomes. A program that rewards patients fi nancially for reaching measurable health goals has the potential to reduce issues of cost and compliance, 2 important obstacles to quality care. I therefore propose a new system: pay patients for performance (PP4P). WHAT PP4P WOULD LOOK LIKE 262 PAY PAT IEN T S F O R P ER F O R M A NC Ebe in the form of health care credits, which can be used toward discounts on medications, health insurance, procedures, and co-payments. The credits can be added onto the patients' health cards at their doctor's visits. When patients achieve preventive health goals, such as getting cancer-screening examinations at recommended intervals, they also earn credits. When they exercise, they can wear a heart rate monitor and bring the recordings to their employer to add credits to their health card, so employers can share administrative costs of updating the cards. By rewarding preventive care and healthy behaviors, this system will also ben...

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