Here’s another dimension of the move toward outcome-based pay for providers. In a recent New York Times op-ed piece, Dhruv Khullar, a NewYork-Presbyterian Hospital doctor and researcher at the Weill Cornell Department of Healthcare Policy and Research, reflects on the difficulty in reaching similar outcomes for patients with radically different incomes and lifestyles.
“Value-based payment models try to measure quality, outcomes and costs — and reward or penalize providers based on their performance,” Khullar observes. “They generally adjust for patients’ medical problems, but not social ones.”
His experience as a resident with a load of impoverished patients showed him the flaw in buried within an unadjusted value-based payment system. “What strained our abilities,” Khullar writes, “was not our patients’ medical complexity, but their social problems: They were poorer, less educated, more isolated, from rougher neighborhoods. We quickly learned that while it’s hard to dose insulin, it’s harder still for a patient who speaks no English, has no refrigerator and regularly has his medications stolen.”