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Abstract:
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At the beginning of the decade, the Institute of Medicine shone an unfavorable spotlight on the health care reimbursement system in the U.S., highlighting its perverse reinforcement of patterns of care that result in high costs and patient harm. Since that time, there has been a surge in the adoption of performance-based incentives by a variety of payers. Experimentation with and debate about pay for performance has had an important side effect: renewed interest in broader payment reforms. In this presentation, I describe the experience with pay for performance and survey the landscape of subsequent provider payment innovations in the U.S. (or renovations, perhaps). I conclude with a discussion of the strengths, weaknesses, and prospects for genuine reform along the lines of current proposals and pilot efforts.
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