Change the Incentive; Change the System of Care

philosophyImage  What if healthcare really focused on outcomes that matter to patients?  What if payment for services was based on whether someone’s cholesterol level went down, diabetes was under control, they quit smoking, lost ten pounds, returned to work without complications from surgery? What if effectiveness for mental health services were shown by number of individuals able to hold a job (or get a job) or maintain a living situation of their choice. What if cancer care effectiveness was measured by whether a patient could maintain normal routines for family and work and whether their emotional well-being was valued on equal basis with the “stage” of their tumor?

What if we stop measuring events that shouldn’t happen and start really aiming for the outcomes we want in healthcare?  What if we truly focus on prevention – the version that is focused on promoting an individual’s best health opportunity rather than wasting hours and dollars chasing after non-hand washers, vaccine shirkers, “non-adherent” patients, fraudulent billers and innovators out to make a quick buck with no commitment to improving health.

That’s why a focus on value and payment based on care “episodes” is intriguing. Pay for care that accelerates an individual toward the good health outcome they want and deserve. The burden is on everyone involved – patient, family, provider – to think about methods and interventions to achieve their goals, instead of focusing on units of service and time, or ticking a box for monthly contact.  It’s certainly no guarantee that the outcome will be achieved. That’s another discussion about our need to accept the realities of illness and mortality.  But it’s a best shot at a system that focuses on health and care for the individual first.

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