Despite research that shows current methods of healthcare reimbursement don't encourage efficiency and efficacy in treating chronic conditions, a new study finds little has been done to bring innovation to payment systems.
Most efforts to improve care for patients with chronic conditions have been aimed at vendors, such as disease management firms, with little effort being aimed at methods used to pay physicians and hospitals, according to the report from the Center for Studying Health System Change.
The study was commissioned by the California HealthCare Foundation.
"The lack of payment innovation for chronic disease care is particularly disconcerting because the prevalence of many chronic conditions is rising, along with related healthcare costs and diminished quality of life for more Americans," said Ann Tynan, a health researcher for HSC and a co-author of the study.
The study's findings, detailed in a new HSC research brief titled "Getting What We Pay For: Innovations Lacking in Provider Payment Reform for Chronic Disease Care," are based on interviews with observers across the country, including medical directors of national, BlueCross Blue Shield, regional and local health plans, employer groups, purchasers of healthcare, and others, from September 2007 to January 2008.
Along with describing several pilot programs designed to alter financial incentives for providers caring for chronically ill patients, the study identifies the main barriers to reforming payment for chronic disease care. They include fragmented care delivery, lack of payment for non-physician providers and services supportive of chronic disease care, potential for revenue reductions for some providers and lack of a viable reform champion.
"Existing payment systems, primarily fee-for-service, encourage a piecemeal approach to care delivery rather than a coordinated approach appropriate for patients with chronic conditions," said Paul B. Ginsburg, president of HSC, a nonpartisan policy research organization funded in part by The Robert Wood Johnson Foundation. "We get what we pay for in healthcare, and as long as we pay physicians and hospitals in a piecemeal fashion, we're generally going to get piecemeal care."