"Behavioral economics is the emerging "secret sauce" for creating incentives to help direct desired behaviors.
Several case studies presented and discussed at Nudging Physicians Toward Value: Incentives in the Era of MACRA-Economics provided health system and payer innovation strategies.
Lets face it, US healthcare spending is out of control. David Blumenthal, MD, MPP and President of The Commonwealth Fund described it best. If we floated our healthcare "spend" out as an island it would be the world's 5th largest economy. Pretty sobering no?
Paying incentives upfront also triggers a behavioral response called loss aversion. A clinician is paid in advance of actual metrics. The "loss aversion" translates into a more focused approach toward quality of care to avoid monetary loss. Think of bundled payments for example.
A variety of behavioral economics concepts have been implemented to determine how to structure incentive payments. Different panel members shared individual incentives vs. group incentives, transparency of incentives, and self directed comparison of peer performance to influence behavior.
Future posts will unpack the specifics of the merit-based incentive payment system (MIPS) and advanced alternative payment models (APMs) but from a topical perspective--they don't seem that different from fee-for-service.
I see a similar conundrum with APMs. Incentive payments can range from tens of thousands to several hundred thousand dollars for specialty care. That amount of money is significant and can drive care to the other extreme. Do physicians with adequate training around evidence quality and high-value care really need cash incentives to make optimal decisions at the point of care? If rationing care brings extra compensation to an individual, group, or hospital--what happens to the patient?
An idea I would like to put forward? Why don't we monitor the fire-hose of marketing messages embedded in clinical trials? How can we improve perception and evaluation of clinical messages? My friend Amy Herman has written a beautiful book about Visual Intelligence that helps me guide discussions about critical thinking and how we communicate evidence in clinical care.
Ellsworth Kelly's beautiful painting Austin, 2015 (exterior rendering) stimulates discussions about what we observe and how we can become better critical thinkers. Take a few minutes to observe the painting.
Observation--the taking in of detail--is objective. Perception--how we interpret what we observe--is subjective. We draw conclusions and make decisions based on our perception, which can be influenced by more than a dozen factors, including education, experience, values, and whether we got a good night's sleep. The better we understand what might alter our perception, the more accurate our observations will be.--BY LEIGH BUCHANAN Editor-at-large, Inc. magazine
Is it possible we are selling clinicians short? Do they really need extreme incentives to "do better" or do they just need better perception and critical thinking tools?
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