|Innovations Lacking In Provider Payment Reform For Chronic Disease Care
Despite wide recognition that existing physician and
hospital payment methods do not foster high-quality and efficient care
for people with chronic conditions, little innovation in provider
payment strategies is occurring, according to a new study by the Center
for Studying Health System Change (HSC) commissioned by the California
"Existing payment systems, primarily fee for service,
encourage a piecemeal approach to care delivery rather than a
coordinated approach appropriate for patients with chronic conditions,"
said Paul B. Ginsburg, president of HSC, a nonpartisan policy research
organization funded in part by The Robert Wood Johnson Foundation
"We get what we pay for in healthcare, and as long as we
pay physicians and hospitals in a piecemeal fashion, we’re
generally going to get piecemeal care," Ginsburg said.
To date, most efforts to improve care of patients with
chronic conditions have focused on paying vendors, such as disease
management firms, to intervene with patients or redesigning care
delivery without reforming underlying physician and hospital payment
methods, according to the study.
"The lack of payment innovation for chronic disease care
is particularly disconcerting because the prevalence of many chronic
conditions is rising, along with related healthcare costs and
diminished quality of life for more Americans," said HSC Health
Researcher Ann Tynan, coauthor of the study with HSC Senior Fellow
According to the Centers for Disease Control and
Prevention, chronic conditions cause major limitations in activity for
more than one in every 10 Americans, or 25 million people, and account
for 70 percent of all deaths in the United States and 75 percent of the
nation’s $2 trillion annual medical care costs.
The study’s findings are detailed in a new HSC
Research Brief — Getting What We Pay For: Innovations Lacking in
Provider Payment Reform for Chronic Disease Care. HSC researchers
conducted 33 semi-structured interviews with informed and knowledgeable
observers across the country between September 2007 and January 2008,
including medical directors of national, BlueCross Blue Shield,
regional and local health plans, employer groups, purchasers of
healthcare and other observers.
Along with describing several pilot programs designed to
alter financial incentives for providers caring for chronically ill
patients, the study identifies the main barriers to reforming payment
for chronic disease care, including fragmented care delivery; lack of
payment for non-physician providers and services supportive of chronic
disease care; potential for revenue reductions for some providers; and
lack of a viable reform champion.
Address: Center for Studying Health System Change, 600 Maryland Ave. SW, Suite #550, Washington DC 20024; (202) 484-5261, www.hschange.org.