Pay-for-Performance

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Pay-for-performance in healthcare can take on many different definitions and be conducted by different agencies, employers and organizations. Our expert panelists will discuss which programs are working and which are not.

Some of the pay-for-performance tools the experts will talk about include:

  • ACO is a network of doctors and hospitals that shares financial and medical responsibility for providing coordinated care to patients in hopes of limiting unnecessary spending. At the heart of each patient’s care is a primary care physician.
  • Bundled payments represent one form of alternative payment models (APMs) that are designed to move toward value-based care by incentivizing providers to advance coordination and efficiency of care while also improving quality and outcomes at lower costs. With bundled payments, the total allowable acute and/or post-acute expenditures (target price) for an episode of care are predetermined. Participant providers share in any losses or savings that result from the difference between this target price and actual costs. Knee and hip replacements are currently leading the way for bundled payments.
  • Centers of excellence—specialized programs within healthcare institutions which supply exceptionally high concentrations of expertise and related resources centered on particular medical areas and delivered in a comprehensive, interdisciplinary fashion—afford many advantages for healthcare providers and the populations they serve.
  • Performance incentives:  a very informative article explaining the ins and outs of performance incentives is “What Is Pay for Performance in Healthcare?” You can read it here:  https://catalyst.nejm.org/pay-for-performance-in-healthcare/