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.