We were repeatedly reminded, by a wide variety of experts, that the healthcare system in the United States mainly offers incentives for services and actions, rather than overall results. This distinction is often referred to “fee-for-service” care, as opposed to “value-based” care. While different experts spoke to varied aspects of what constitutes “value” in care, they consistently emphasized that most health professionals, especially physicians, are given incentives not to provide overall “ownership” of a patient’s health, but rather to complete a particular service as efficiently as possible, often with little emphasis on the overall picture. The message that was made clear to us was this: to expect wide-scale changes in the way that care is delivered, there is dire need to provide top-down changes in incentives and reimbursement. In addition to moving to a healthcare system that values better health outcomes, as opposed to volume of services, future health care reimbursement should also account for the acuity and complexity of patients and populations, as to not discourage physicians from taking on highly complex or vulnerable cases. In the absence of such top-down, systemic change, healthcare providers who wish to provide comprehensive care may often do so at significant extra burdens.
