Last week’s New England Journal of Medicine had a Perspectives piece by Meredith Rosenthal, “Beyond Pay for Performance — Emerging Models of Provider-Payment Reform.” Rosenthal does a reasonably good job of summarizing progress thus far but she omits an important consideration in structuring reimbursement to encourage the provider behavior we desire.

Not nearly enough has been done thus far to encourage and hold providers accountable for communication with, and engagement of, their patients. We know that high-quality health care is partially (and substantially) based on effective communication, patient understanding, and consumer engagement (several posts on this blog have cited relevant studies in support of this fact). However, most pay-for-performance (P4P) models don’t explicitly try to address this issue.

To provide an instructive example of an exception that proves the rule, look at the MedEncentive approach. It provides two types of incentives. It rewards physicians for prescribing information therapy (Ix) and following evidence-based guidelines (or explaining why they don’t in specific circumstances).

Second, and unlike other P4P approaches, it also offers incentives to patients for filling their information prescriptions (going to the URLs where relevant evidence-based information is provided) and for confirming through a brief survey that their clinicians communicated appropriately and effectively with them. Preliminary results from MedEncentive suggest not only significant cost savings and high patient satisfaction but also a shift in payment from more intensive to less intensive settings, one of the goals of payment reform noted by Rosenthal.

In her article, Rosenthal summarizes the P4P/payment reform body of research, “There are, fundamentally, no ‘new’ methods of health care payment.” On the other hand, she didn’t describe the dual-incentive (patient as well as provider) approach and didn’t discuss much about how to enhance patient-physician communication and consumer engagement.

As payment reform initiatives evolve, particularly with the renewed popularity of the old idea of the patient-centered medical home (known by other names in the past), it’s important that these patient perspectives on performance are measured and rewarded.

This entry was posted on Wednesday, September 24th, 2008 at 3:06 pm and is filed under Engaging Consumers, Market Rewards/Reimbursement Issues, Patient-Centered Medical Home, Patient-Clinician Relationship, Performance Measurement. You can follow any responses to this entry through the RSS 2.0 feed. You can leave a response, or trackback from your own site.