Linking Care Outcomes With Reimbursement

During this segment, the panelists further discuss patient-centered care and explore the challenges that managed care stakeholders face as they attempt to establish new payment models that link reimbursement to measures of overall performance and outcomes of care.

As patient-centered care becomes the new standard, changes in the overall payment structure are expected to happen very quickly, explains Scott Gottlieb, MD. Although linking compensation to actual clinical care is a challenge, Dr Gottlieb and Brian Kiss, MD, suggest that patient-reported outcomes can be useful when establishing a new payment model.

Dr Kiss suggests that patient-reported outcomes (eg, adverse events) should be evaluated rather than patients’ functional statuses as determined by clinicians. Patient reports generally describe adverse events in much greater detail than physicians’ assessments do.

Government agencies should focus on assessing experiences and outcomes from the patients’ perspectives, adds Dr Gottlieb, as measuring what is happening in the clinical setting can be challenging.

Michael Kolodziej, MD, and Ted Okon, MBA, note that private payers are leading the way in payment reform. Mr Okon notes that while government programs are using antiquated systems incapable of bringing all the data together for use in evaluating quality, private payers are taking the lead in terms of combing data to evaluate outcomes.