In a recent Robert Wood Johnson Foundation report and Health Affairs blog post, de Brantes argues that as healthcare moves toward reform, it still must construct payment models that truly reflect variations of care, and incentives in provider contracts. In addition, reforms must overcome a myriad of issues ranging from innate isolation among physicians involving fiscal matters in health care systems, to dealing with improper self-referrals among physicians, he says.
Inevitably, the "carrot-and-stick" approach for physicians, whether pay-for-performance, capitation, wellness bonuses, bundled payments or consumer-directed health plans, often fall short of their goals and must be re-examined, de Brantes writes.
Poorly constructed financial models inevitably undercut physician motivation and result in undesired patient outcomes. Healthcare, inevitably, should look toward the private-sector business world to improve its efficiencies and outcomes, de Brantes says.
"Undeniably for healthcare providers, the motivation to properly care for patients and 'do no harm' significantly impacts the treatment decision-making process," de Brantes writes. "However, this motivation has been sapped by poorly designed incentives. The challenge we face in healthcare is to figure out how to reverse the incentives that currently encourage doctors, nurses, and others to make inefficient and potentially harmful health care choices."
"Said plainly, it's tough to be good when you're constantly encouraged to be bad," de Brantes says.