June 20, 2009

On incentives in chronic care


Just reading McKinsey's report on the structure and risks of health care services. An interesting read even though it doesn't go into any detail about the proposed changes in financing and customer incentive shifts.
In chronic care services it would definitely be beneficial to shift reimbursements away from fee-for-service to outcome/indicator based. This reminds me of an interesting discussion I've had with Dr David Paynton (from Southampton City Primary Care Trust, UK) at last year's Southampton Conference on the future of primary care.
As I was just presenting process support for treatment of patients with depression (improvehealth.eu) I wanted to get his feedback on possible implications on financing of long-term care (process based reimbursement system). He argued that insurance companies/health care trusts should focus on performance indicators (i.e. measurable indicators of quality of care) instead of delving into processes of care. I agree to a certain extent but still think it's important to promote and reward compliance of providers with best process of care. This could be done by reporting from process support systems whether individual patients (instances) are handled accordingly to the predefined process.

The reasoning behind it would be that providers will always play the reimbursment model. The more complex it is, the more difficult it is to play. So instead of defining 3 quality indicators for let's say diabetes treatment quality, we could also add real-time compliance with the predefined optimal process of care. This could be solved with a single additional indicator stating the level of compliance.
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