We must stop financially rewarding underperformance in care and prevention. Paying hospitals, doctors, and other parts of the health system only on the basis of the volume of sick care they provide offers no incentive to keep populations healthy. Doing so provides no business case for provider systems to find better ways to maintain health and avoid preventable complications of chronic diseases. Models like ACO’s could be very helpful in this regard, but alone are insufficient to achieve the goal of creating health systems that are more effective in preserving and restoring health. Why? Because we have a huge knowledge gap that monetary incentives alone simply cannot fill.
The situation is analogous to providing financial incentives to health systems to improve the outcome for a refractory form of fatal cancer. Does the promise of more money in exchange for a better outcome for such patients magically enable the health system to increase a patient’s survival and ensure a better quality of life? No. Research and new knowledge about what forms of treatment are more effective is required. Likewise, intensive research about systems innovations, and care model delivery redesign is essential to bringing about healthier populations served within ACO models. The assumption that the knowledge already exists and the only thing missing is the will of health system leaders and financial incentives is the most dangerous trap facing health care reform.
Everyone agrees that you can’t cure cancer without real scientific knowledge and evidence-based research demonstrating the comparative effectiveness of various treatments. Somehow, though, when it comes to redesigning systems of care, everyone assumes that it is only a matter of management intention; not knowledge or scientific evidence of system effectiveness. Wrong. It’s a very similar challenge. We do our health system leaders a grave disservice by ignoring the fact that they too need a rich evidence-base to guide the complex task of system redesign.
Why aren’t we further along in our understanding of how to redesign systems for more effective prevention and improved population health outcomes? First and foremost, we wrongly assume research is not needed – we think that innovation driven by immediate business incentives alone will get us there. While innovation of this kind can make a real contribution – it will not be enough. We should instead be mounting the same types of massive research initiatives we did for AIDS and cancer research. Maybe the results won’t be published in the same kinds of biomedical journals as those efforts, but high-quality, robust, and long-term research in order to discover effective means to redesign our system combined with financial incentives to do so is our only hope for developing a health system that is affordable and able to optimize the length and quality of human life.
Everyone agrees that you can’t cure cancer without real scientific knowledge and evidence-based research demonstrating the comparative effectiveness of various treatments. Somehow, though, when it comes to redesigning systems of care, everyone assumes that it is only a matter of management intention; not knowledge or scientific evidence of system effectiveness. Wrong. It’s a very similar challenge. We do our health system leaders a grave disservice by ignoring the fact that they too need a rich evidence-base to guide the complex task of system redesign.
Why aren’t we further along in our understanding of how to redesign systems for more effective prevention and improved population health outcomes? First and foremost, we wrongly assume research is not needed – we think that innovation driven by immediate business incentives alone will get us there. While innovation of this kind can make a real contribution – it will not be enough. We should instead be mounting the same types of massive research initiatives we did for AIDS and cancer research. Maybe the results won’t be published in the same kinds of biomedical journals as those efforts, but high-quality, robust, and long-term research in order to discover effective means to redesign our system combined with financial incentives to do so is our only hope for developing a health system that is affordable and able to optimize the length and quality of human life.