Segment 8 - Financial Incentives and Penalties

Panelists analyzed the concept of penalizing providers who deviate from pathway programs.

Dr Malin said rather than having a penalty, WellPoint chooses to incentivize behavior. When providers select treatments that are “off pathway,” they are reimbursed, but there are additional financial incentives for providers who select treatments that are “on pathway.”

Dr Yu agreed that incentives to change are preferable to penalties. He added that payers should not seek to penalize either— incentives should be determined internally from institutions or at the provider-group level.

Dr Nabhan said that by not achieving a certain pathway metric, a provider technically “penalizes” him or herself by missing the potential financial incentives that are available to them.