September 23, 2021

Incentives in digital health

 Paying for Digital Health Care — Problems with the Fee-for-Service System

From NEJM:

Without payment-system changes, we can expect to have many unhappy patients and physicians struggling with this complex payment labyrinth. Only a payment system that encompasses some form of capitation will eliminate these issues.

The status quo isn’t viable, the current approach that relies on determining payments for each type of digital interaction is destined to fail because such interactions aren’t distinct services that can be easily differentiated. Unless we move rapidly toward capitated models, the health care system will continue to deliver suboptimal, non–patient-centered care that fails to harness the potential of the technology that  exists all around us.

PS . Topol on value-based care: It’s a joke, value-based care. Basically, we have one-third of the healthcare, but $3.6 trillion is waste—low-value care. We need to stop that. That’s part of why it’s so costly. And so this whole idea of value-based care doesn’t even get to it. There’s a long list of hundreds of things that each of the professional societies have called out as being shouldn’t be done anymore. And we’re doing it every day, you know, thousands, hundreds of thousands of times, every day and week in this country. We have to get rid of the waste and inappropriate and unnecessary care and we haven’t done anything to do that here of note. 

Palermo, 1963