ACA Pay-For-Performance Programs Not Living Up To Expectations Interview with:

Dr. Igna Bonfrer PhD Post-Doctoral Research Fellow Harvard T.H. Chan School of Public Health 

Dr. Bonfrer

Dr. Igna Bonfrer PhD
Post-Doctoral Research Fellow
Harvard T.H. Chan School of Public Health What is the background for this study? What are the main findings?

Response: One of the two main elements of the Affordable Care Act, generally known as Obama Care, is the implementation of value based payments through so called “pay-for-performance” initiatives. The aim of pay-for-performance (P4P) is to reward health care providers for high-quality care and to penalize them for low-quality care.

We studied the effects of the P4P program in US hospitals and found that the impact of the program as currently implemented has been limited. What should readers take away from your report?

Response: Value Based Purchasing, as currently structured in the US, is not living up to the promise advocates originally envisioned. Given its cost, policymakers in the US should consider retooling the current program.

There are a few ways that this may be done. First, the program should consider increasing the incentives at play. Currently, the small amount of money at stake is arguably not enough to really shift the way hospitals are doing business.

Second, policy makers should focus on a few measures that matter most to patients. Mortality, patient experience and functional status are important ones. What recommendations do you have for future research as a result of this study?

Response: Currently, several experiments with Affordable Care Organizations and bundled payments are ongoing. These can provide additional or alternative routes towards increased value in the US health care system. Rigorous impact evaluations to study the effectiveness of these programs will be very valuable to increase our understanding of incentivizing value and not just volume. Thank you for your contribution to the community.


Impact of Financial Incentives on Early and Late Adopters among US Hospitals: observational study

BMJ 2018; 360 doi: (Published 04 January 2018)

Note: Content is Not intended as medical advice. Please consult your health care provider regarding your specific medical condition and questions.







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