• 3 Ways to Incite Value

    From the Editors Jun 06, 2013

    Like everything in health care, inspiring value is complicated.

    Yes, money can help bend the performance needle in a positive direction. But financial incentives are only one part of a complex equation that healthcare leaders are still trying to nail down. 

    Below are three things that we learned about incentives and value from this issue of Leadership. 

    Detailed data inspires. Many experts stress that one of the best ways to improve quality and reduce costs is to give staff trustworthy data that details how their performance compares to their peers. 

    Bruce Gould, MD, medical director, Northwest Georgia Oncology Centers, would agree. As described in the article "At the Forefront of Payment Reform," Gould’s practice is participating in a UnitedHealthcare pilot that shares detailed cost and quality data with oncologists. “I’ve been a practice manager for 15 years, and … this is the first time we have received very structured feedback in terms of what it costs to take care of patients...” 

    The growing availability of detailed performance data is enabling more providers to pinpoint specific improvement strategies. For example, in the article "Improving Efficiency Scores Without Harming Quality," Susan Dragoo, director of quality and innovation, INTEGRIS Health, describes the gold mine of data available from Medicare about hospital efficiency scores. “If people take the time to review these reports, then the reports will be helpful.” 

    The specifics speak volumes. In the article "Successful Physician-Hospital Alignment," we learn about two pay-for-performance initiatives involving physicians. In Geisinger’s successful approach, 20 percent of an employed physician’s salary is based on specialty-specific cost and quality targets. Well received by physicians, the approach is improving quality and efficiency. 

    In contrast, the New York City Health and Hospitals Corp. is facing significant barriers in rolling out its new pay-for-performance payment approach to physicians. “...the devil is in the details,” says Luis R. Marcos, MD, CEO for the Physician Affiliate Group of New York. “It’s going to take time and a lot of good communication and teamwork.” 

    The mission matters. In his interview, Donald Berwick, MD, makes a distinction between incentive systems that work for corporations and those that work for individuals. “I think we need to be very careful about identifying where pay for performance is an asset and where it actually may do some damage,” says Berwick, president emeritus and senior fellow, Institute for Healthcare Improvement. “Most doctors would rather be appealed to on the high ground about their professionalism, their missions in life, their craftsmanship, their peer relations.” 

    CEO Benjamin Anderson lived this lesson when he took on the challenge of recruiting physicians for a 24-bed critical access hospital. Taking the advice of local physician faculty, Anderson successfully recruited physicians with a hospital policy that gives all staff four to eight weeks off a year to pursue international medical mission work. 

    These are just three lessons from the many that can be found in the Summer 2013 issue of Leadership magazine, told by dozens of healthcare providers who are working hard to create a higher quality, more cost-efficient healthcare system. We hope you find many other inspiring and useful take-aways.