Insurers changing payment models

Health insurance companies have tried a variety of different payment models, but the predominant model continues to be fee-for-service, where physicians get paid more for doing more. Recently, there has been more talk about insurers paying for value, not just for the volume of procedures done. A survey cited by The New York Times estimates that 20% of reimbursements are tied to care improvement and reduced costs. That sounds remarkably high given the lackluster uptake of pay-for-performance (P4P) even just five years ago. This could be a welcomed trend for the discriminating consumer of health care services.

Questions to watch as this trend unfolds:

1) Will physicians encounter situations where there is a conflict of interest? (e.g. maybe skipping a test that might be useful in order to qualify for a value payment)

2) Will physician engagement be better than the P4P schemes of the last decade?

3) Will patients notice the difference?

4) Will these care quality assessments be made public so that patients can choose accordingly?