Care Redesign
Clip
A Cry for Encouraging Disruption in Health Care (04:16)

When it comes to the issue of incentives and driving both form and function, how much should we trust the baseline? How do we grapple with the idea of rewarding efficiency when it may seem counterintuitive to those of us who are concerned with fairness?

“Originally, competing against your baseline may have made sense, but over time, no matter if you were high cost or low cost — you can’t always compete against your own baseline. So we’re trying to think about how you adjust the financial benchmark,” says Patrick Conway, Deputy Administrator for Innovation and Quality and CMO at Centers for Medicare and Medicaid Services, adding that they’re trying to think about how to adjust the financial benchmark in order to better allow for lower-cost, high-quality providers to be successful.

“The end state is, can we successfully deliver better quality care for patients at a lower cost?” says François de Brantes, Executive Director of the Health Care Incentives Improvement Institute. “And in doing so, try our very best not to stifle innovation in the delivery system but quite the contrary — to do everything that we can to stimulate different forms?”

Where we’re learning the most, de Brantes adds, is innovation and disruption. “If you look at the history of innovation, and there’s a tremendous amount of innovation and disruptive innovation in business, it never comes from the incumbents. Ever.”

So how do we avoid stifling innovation and encouraging disruptive innovation? “It’s a very difficult task,” de Brantes says, explaining how every time CMS tries to do something new, people “whine” to their senators and congressmen. “We’ve got to get out of that, right? It’s coming to this fundamental realization, it’s not about you, it’s about the patient — and of course the patients’ voice is rarely represented in the lobbyist rooms, and it’s a huge challenge for all of us,” he says.

Conway agrees. “I think the end state is around the patient — better care, better health, smarter spending. How we get there, we’re going to learn along the way. And we shouldn’t bake in too many rules or barriers, or we inhibit innovation and change, I agree. I do think, on the incentives side, it is likely that we will go to a much higher percentage than alternative type payment models or fee for service because I think the incentives are closer to better care, better health.”

 

From the NEJM Catalyst event Care Redesign: Creating the Future of Care Delivery at Kaiser Permanente Center for Total Health, September 30, 2015.

More From Care Redesign
The Assessment of Care Tool - Consisting of Six Visual Analog Scales Corresponding with the IOM Six Dimensions of Perfect Care

Real-Time Pursuit of Outcomes That Matter to Patients

A simple and affordable tool to use at the point of care to drive value creation within clinical microsystems.

Many Patients Who Would Benefit from Palliative - End-of-Life Care Do Not Receive It

Care Redesign Survey: The Power of Palliative Care

Our NEJM Catalyst Insights Council survey on palliative care reveals an interesting dichotomy: While the great majority of organizations have a palliative or end-of-life care program, 60% of patients who would benefit from such services don’t receive them.

Heart Safe Motherhood and Way to Health Two-Way Texting for Blood Pressure Monitoring for Postpartum Women with Preeclampsia

Heart Safe Motherhood: Applying Innovation Methodology for Improved Maternal Outcomes

At the Hospital of the University of Pennsylvania, a text message–based blood pressure surveillance program for postpartum women with preeclampsia improved blood pressure management, reduced readmissions, and increased patient and provider satisfaction.

VHA Whole Health System diagram

Finding the Cause of the Crises: Opioids, Pain, Suicide, Obesity, and Other “Epidemics”

Until we redesign our health care system to address our patients’ personal determinants of health, we will continue to inadequately address our multiple chronic disease crises.

Leff06_pullquote home-based medical care for homebound patients

Using Quality to Shine a Light on Homebound Care

How two thought leaders in the fields of home-based medical care, geriatrics, and palliative medicine advanced a quality-of-care agenda for homebound adults.

Charlotte Yeh head shot - hearing aids hearing loss

“You’re Old Without Hearing Aids”— Addressing the Silent Epidemic of Hearing Loss

Hearing loss isn’t a normal consequence of aging. But it is associated with a higher risk of dementia, depression, and falls. The Chief Medical Officer for AARP Services talks about combating this huge but silent epidemic that impacts all ages.

Dentzer01_pullquote - Stone-Age Policies Stifle Modern Virtual Care Solutions

Stone-Age Policies Stifle Modern Solutions

Health care leaders must advocate for regulatory and reimbursement changes to unlock the potential of innovative technology and care team approaches to Parkinson’s and other suitable conditions.

Idiopathic Pulmonary Fibrosis IPF Multidisciplinary Collaborative Care Model

From Consulting to Caring: Care Redesign in Idiopathic Pulmonary Fibrosis

A multidisciplinary collaborative model to address the palliative care needs of patients with idiopathic pulmonary fibrosis resulted in improved end-of-life care and decreased hospital deaths.

Impact of PCSP on Patient Satisfaction at Providence Heart Clinic

Transforming Specialty Practice in Pursuit of Value-Based Care: Results from an Integrated Cardiology Practice

Despite significant primary care reform around patient-centered medical home models, specialty care remains fragmented, with poor communication between primary care and specialists. How should specialty practices be reformed to deliver more coordinated, patient-centered care?

Michael Bennick Yale New Haven Hospital Medical Director of the Patient Experience - Yale Living History Project

The Living History Project: Open-Ended Patient Interviews Create a Therapeutic Bridge

A program at Yale has students conduct open-ended interviews with patients about their lives, their hopes, their values, and what they most want their medical team to know — creating the opportunity for human connection and a better care experience.

Connect

A weekly email newsletter featuring the latest actionable ideas and practical innovations from NEJM Catalyst.

Learn More »

Topics

Coordinated Care

136 Articles

Care Redesign Survey: The Power of…

Our NEJM Catalyst Insights Council survey on palliative care reveals an interesting dichotomy: While the…

Primary Care

188 Articles

China’s Health Care: Public Benefit, Enormous…

Though demand for health services in China has outpaced the development of management systems to…

Mental Health

30 Articles

Finding the Cause of the Crises:…

Until we redesign our health care system to address our patients’ personal determinants of health,…

Insights Council

Have a voice. Join other health care leaders effecting change, shaping tomorrow.

Apply Now