Norbert Goldfield is one of the more sophisticated and deep thinkers on the topic of integrating financial incentives with patient care improvement. He and Richard Fuller recently addressed the issue of the segmentation of different kinds of patients under such programs. Here's a teaser:
"It is evident that mental health issues drive increased utilization and, particularly within Medicaid programs, increase the likelihood of readmission. Poorly constructed penalties, apparent in many earlier health management efforts, look at the frequency of readmission at an institution, typically a hospital, and conclude that the hospital patient population as a whole has high rates and therefore the hospital performance merits a penalty. The result is a push to exclude and dilute the impact of patient populations that generate this loss, while the providers that treat them are seen as “loss centers.” The resulting mindset is a pervasive fear in which complex, high-needs patients that require more resources will uniformly experience higher rates of adverse outcomes, leading to them being identified as a problem.
"Exclusion from incentive programs may remove patient populations from the radar of cost-cutting administrators but will also ensure that attempts to improve their care will not be a top priority.
"But, with better crafted policies this need not be the case – in fact the reverse is true."
"It is evident that mental health issues drive increased utilization and, particularly within Medicaid programs, increase the likelihood of readmission. Poorly constructed penalties, apparent in many earlier health management efforts, look at the frequency of readmission at an institution, typically a hospital, and conclude that the hospital patient population as a whole has high rates and therefore the hospital performance merits a penalty. The result is a push to exclude and dilute the impact of patient populations that generate this loss, while the providers that treat them are seen as “loss centers.” The resulting mindset is a pervasive fear in which complex, high-needs patients that require more resources will uniformly experience higher rates of adverse outcomes, leading to them being identified as a problem.
"Exclusion from incentive programs may remove patient populations from the radar of cost-cutting administrators but will also ensure that attempts to improve their care will not be a top priority.
"But, with better crafted policies this need not be the case – in fact the reverse is true."
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