Comparing Strategies for Improving Value in Health Care: The Physician's Perspective

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<p>Payers are trying new ways to bring rapidly increasing health care costs under control, from pay-for-performance programs and public reporting of quality and cost information, to tiered provider networks and consumer-directed health plans. A new Commonwealth Fund <a href="/cnlib/pub/enews_clickthrough.htm?enews_item_id=30842&return_url=http%3A%2F%2Fwww%2Ecommonwealthfund%2Eorg%2Fpublications%2Fpublications%5Fshow%2Ehtm%3Fdoc%5Fid%3D607846%26%23doc607846">report</a> reviews concerns that have emerged over several of these strategies and offers specific assessments of each one.<br><br>The authors--all physicians with the Rochester Individual Practice Association--question in particular the utility of programs that seek to "judge" the overall quality of a doctor. They argue that judgment-based strategies undermine collaboration among stakeholders, making it more difficult to implement system-wide changes.<br><br>"Results to date lead us to conclude that, in the health care industry, basing change on the foundation of win-lose relationships does not work," the authors find.<br><br>Quality-improvement approaches that incorporate incentives and accountability, they say, "offer a more constructive model for an effective and efficient health care system." The authors believe partnerships are needed to coordinate physician behaviors, provide a continuum of services, and ensure that evidence and patient-centeredness underlie medical decision-making.</p>