This is a decent blog post about the frailties of paying for performance, providing interesting observations on the disabling impact of financial incentives associated with intrinsic motivation in nuanced professional jobs (a la Dan Pink).
It also gives some interesting insights into how the structure of incentives to address cognitive biases like loss aversion to deliver greater impact e.g. paying up front for quality with the possibility of a refund on those payments if the measures are not met.
From the last paragraph: “While health care providers want to help the patient in front of them, they may not feel obligated (or have the incentive) to solve system-level problems stemming from factors they feel are outside their control. One potential solution lies in broader health reform, such as global payment for populations rather than piece-rate bonuses for individual patients. Coupled with public quality reporting, global payment reform has the potential to expand the scope of provider accountability, take advantage of providers’ intrinsic motivation, and improve population health. Such efforts may hold more promise for value improvement in US health care than attempts to exploit providers’ extrinsic motivation through tweaks to fee-for-service payment.”
I think we need to fire up both the clinician’s and patient’s intrinsic motivations to drive real improvements in health. Some sort of clinician involved version of the Vitality Group program.