Lessons from behavioral economics can help hospitals, physicians and payers determine how to most effectively tie payment to performance and value, a group of executives said Thursday.
A panel of healthcare experts and organizational leaders who began adapting to value-based payment years before the Medicare Access and CHIP Reauthorization Act started fleshing out regulations talked about their programs at the event sponsored by the Commonwealth Fund.
The panel agreed that performance goals should include a number of targets instead of one hard and fast goal. Also, providers need to clearly understand how their actions determine their pay and get quick feedback.
There were differences, however, in how the organizations have approached using individual goals or group goals.
Patrick Conway, director of the Center for Medicare and Medicaid Innovation at the CMS, said incentive designs have been all over the map and it remains to be seen which may be more effective.
“In my mind it's still an unresolved question,” he said.
He said the CMS has learned from the efforts of the early adapters. It has found that peer-to-peer education is a key driver of change and that feedback on all levels must be timely, transparent and actionable.
Dr. Sree Chaguturu, vice president of population health management at Partners Healthcare, said the Boston-based system elected to favor group incentives so there was not an unintentional push to restrict care instead of a focus on value. Also, no individual doctor had an undue financial risk and there wasn't the concern of dealing with numbers too small to make accurate conclusions.
This, along with unblinded performance measures, create peer pressure and shared accountability, he said.
The organization has learned that small incentives can go a long way, as long as those getting paid have control of the performance measures. Also, for the incentives to be successful, the timeframe between performance and reward needs to be as short as possible, he said.
Dr. Pankaj Patel, senior medical director at Advocate Physician Partners, echoed this and said doctors need to clearly see how their actions affect their pay. To help with this, APP shows the doctors how much they left on the table and what they could have done to earn it.
Dr. Zeke Emanuel, an architect of the Affordable Care Act now at the University of Pennsylvania, said one big challenge as the industry moves forward with value-based payment is how it has to rely on the fee-for-service payment architecture for practical reasons.
“We know that having a foot in each boat ... is not a good thing,” he said.