Abstract
Policy makers (both public and private) are seeking ways to improve the value delivered within our health care system, that is, using fewer resources to provide the same benefit to patients, or using equivalent resources to provide more benefit. One strategy is to alter the predominant fee‐for‐service (FFS) economic incentives in the current system. To inform such policy changes, this paper identifies areas in which little is known about the effects of specific incentives (FFS, salary, etc.) on the two components of value: resource use and quality. Specific suggestions are offered regarding research that would be informative for policy makers, focusing on fundamental “building block” studies rather than overall evaluations of complex interventions, such as accountable care organizations. This research would better identify critical aspects of the FFS model and salary‐based payments that are particularly problematic, as well as situations in which FFS or salary may be less problematic. The research would also explore when alternatives, such as episode‐based payment might be feasible, or simply be hypothetical solutions. The availability of electronic health record‐based data in various delivery systems would allow many of these studies to be accomplished in 3–5 years with budgets manageable by public and private funding sources.
Highlights
This paper suggests a series of research questions to help improve incentives for higher value health care delivery
The goal of this paper was to highlight some issues around improving economic incentives where much more research is needed to fill in knowledge gaps
Research demonstrating how crucial problems are associated with a proposed solution or that the intervention failed to achieve its goals in an “ideal” setting should give policy makers pause
Summary
Policy-Oriented Research on Improved Physician Incentives for Higher Value Health Care. “higher value” means health care that either uses fewer resources to provide the same benefit to patients (as they perceive it) or uses equivalent resources to deliver more benefit Other papers in this collection address theoretical concerns and opportunities for improving economic incentives, as well as the current evidence on existing innovative approaches. We would be collecting data on how organizations (both old and new) are using, modifying, and developing incentives for clinicians as their external environment is changing and how well those new incentives are achieving their goals Such a research project, is beyond the scope of the studies envisioned in this paper. Those two criteria exclude an effort to really understand how organizations are internally changing to adapt to the new policy environment
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