It’s generally understood that addressing quality and cost challenges in today’s healthcare environment will require the removal of incentives that favor intervention over outcomes. But that’s easier said than done. Both payers and providers have capabilities, mindsets, and extensive infrastructure in place to support fee-for-service payment. Despite some experimentation with emerging payment and delivery models, there are still significant hurdles to conceptualizing and implementing alternative frameworks.
Payers, however, must take the lead in addressing these challenges. While there haven’t been incentives in the past to make meaningful changes, not doing so now opens the door to competition and disruption. If insurers don’t accelerate the adoption of new payment and delivery models that bend the cost curve and improve outcomes, they will almost certainly find themselves losing share to more sophisticated competitors, disintermediated by integrated delivery networks, or saddled with government mandates and regulations.
Payers must become stakeholders in the success of providers, working in tandem and collaborating in new ways. They’ll need to incentivize providers to deliver care using new approaches. At the same time, they must also redesign their organizations, processes, and systems to enable this major shift in thinking and operations.
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