COMMENTARYPay-for-Performance or Pay for Value?
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A Survey of the Landscape
More than 100 pay-for-performance projects are under way in the United States.3 They are sponsored by government purchasers (eg, Center for Medicare and Medicaid Services [CMS]), employers (eg, General Electric, Ford Motor Company), and health plan coalitions (eg, Integrated Healthcare Association). Most of these incentive programs target a mix of process and structural measures, with less emphasis on patient satisfaction and overall patient outcomes.4
Programs have varying payment approaches,
Creating a Value Ratio at a Macro Level
Mayo Clinic recently hosted its first National Symposium on Health Care Reform, at which 300 national leaders convened and reached consensus on the direction that reform must take. Two of the key recommendations dealt with value. Participants agreed that the health care system needs to deliver value to all stakeholders and that payment should be based on results of coordinated care delivered over time.
We must move away from pay-for-performance approaches that reward process achievement and move
You Get What You Pay For
Dr Robert Nesse, a panelist at the Mayo Clinic National Symposium on Health Care Reform, stated the following:
What would the cost of a hamburger be if, instead of paying for the outcome of good food delivered in a congenial location by friendly service, we actually just paid for the number of cooks… and how many wait staff went by… The economics of health care are not that dramatically different. We are paid for the process; we're not paid for the outcome.
We recognize that some will view
Acknowledgments
We thank Roshelle (Shelly) W. Plutowski for editorial assistance with the submitted manuscript.
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