The Physician-Payer Relationship in Outcome-Based Payment Models

Outcomes based payment models can be complicated.  The requirements for success from a care delivery perspective include, but not limited to, clinical teaming, adherence to Society-specific clinical protocols and guidelines, patient compliance, near-seamless communication and timely reporting and analysis of outcomes.  However, physicians and hospital systems have varying levels of maturity and capability across each of these elements.  Further, the definition of "quality", as well as the definition of "outcome" can be debated.   The effort to move from the current payment models to this more advanced and insightful approach is difficult.  The presentation will discuss the innovative technology and the process design that a start-up insurance company is bringing to the market.  The approach and supporting technology are part of the collaboration with the physicians who have contracted with the insurer to help them learn how to be successful under these new payment models.