Regarding the article “If fee-for-service is a problem, what's the solution?”, replacing the fee-for-service payment model with something better is necessary, but not sufficient to achieve healthcare reform goals of the triple aim—improved health for populations served, better patient experience and lower costs.
Accountable care organization-like payments may be a carrot, but there are too many obstacles in the way of those seeking to grasp it. The story is more complex and nuanced than an either/or decision about payment methodology. It helps to start by acknowledging that fee-for-service has toxic consequences, but the system of healthcare that grew up feeding on that payment model accommodated itself to that “food chain”; its structures, processes and cultures are tightly interwoven. So systemic transformation of all of these dimensions is what is required in addition to payment reforms.
In many cases, the legacy structures of healthcare delivery cannot escape the gravity of fee-for-service payment because they are too much a creation of that outdated system to transform themselves from within. Therefore, it is understandable that there should be significant numbers failing to thrive under the new model. We need some time for rapid-cycle learning.