International Journal of Advance Innovations, Thoughts & Ideas
Open Access

There is a consensus that fee-for-service reimbursement does too little to encourage the provision of high-value care. Our Enterprise, an integrated payer-provider based in Pittsburgh, created an alternative compensation model for endocrinologists. Our plan introduces a gradual shift in the role of endocrinologists from clinical duties to a more collaborative role with their primary care colleagues. Considering that most patients with diabetes are managed under primary care, this shift allows endocrinologists to support primary care physicians in managing patients with diabetes and other endocrine-related illnesses while decreasing the number of traditional in-office referrals to endocrinology [1]. Despite the unexpected changes brought on by COVID, in first 9 months of the compensation model, we observed its impact on care delivery as well as the relationship between participating specialists and PCPs. Practice- and provider-level quality data has shown improvement in diabetes-specific quality metrics. In one year, 16 out of 54 target practices earned NCQA recognition for diabetes management. A total of 88% of participating PCPs reported a satisfaction score > 90% with the new plan. Ultimately, our model shows promise as a replacement for fee-for-service compensation, with a likelihood of lowering costs and improved quality of care.

Health care spending in the U.S. is among the highest, per capita, in the world. Expenses have been rising precipitously, with health care spending at $3.8 trillion in 2019, and the overall share of gross domestic product related to health care spending at 17.7%. Despite our high health care expenditure, the U.S. has failed to deliver the highest quality of health care in the world [2]. An analysis comparing the performance of health care systems in 11 high-income countries concluded that the U.S. ranks last on access to care, administrative efficiency, equity, and health care outcomes . The U.S. has some of the most advanced research, modern technology, and state-of-the-art facilities in the world, but our health care outcomes have failed to match these resources. The fee-for-service mechanism of compensation is considered one of the major drivers of the country's exorbitant health care costs. In March 2012, the Society of General Internal Medicine convened the National Commission on Physician Payment Reform to examine factors influencing such expenditures across the health care system [3]. They identified many important drivers, but fee-for-service reimbursement stood out prominently among them . There is an agreement that feefor- service reimbursement does too little to encourage the provision of efficient, high-value care, with no incentive for the physician to deny services even if they are astronomically expensive and their benefit is questionable. Rather, the current system incentivizes increasing the volume of services, discourages care coordination, and promotes inefficient delivery.

Under our proposed contract, an endocrinologist is compensated for their efforts as measured against designated performance criteria with a conditional incentive payout. While the plan represents a novel value-based payment structure, it also introduces another practical shift into the workflow: supporting primary care providers in a populationbased approach towards diabetes and other endocrine-related disease management. As previously mentioned, moving to a new model should be gradual, with fee-for-service remaining an integral part of physician payment during a transition period [4]. Therefore, our group began implementing this change by creating two separate tracks of compensation: transformative and clinical[5].

Acknowledgement

I would like to thank my Professor for his support and encouragement.

Conflict of Interest

The authors declare that they are no conflict of interest

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