In theory, value-based purchasing depends primarily on the ability of a larger organization to align the incentives and goals of varied parties. At a place like the Mayo Clinic, an employer could go directly there and have a predictable experience for a predictable flat price--while in other organizations, nobody's going to get the bulk of doctors, hospital leaders and ancillary providers on a single page.
To me, one of the main reasons other groups can't duplicate the success of players like Mayo isn't simply because other partnerships don't put their physicians on staff. A deeper reason, I'd argue, is that even when physicians come on board, compensation models still vary so much that physicians may have some widely differing financial incentives.
To name one example, wouldn't a physician who's paid a base salary plus a piece of gross income behave differently than a doctor who's paid on salary plus his or her own production? And wouldn't a third doctor who is paid on a net collections basis work differently than either of the above?
All of this suggests to me that before a bundled payment model emerges, someone will have to develop a physician payment model designed to link physicians more closely to coordination and teamwork. We're talking something of a hybrid between medical home compensation models and pay-for-performance, at minimum.
Readers, have you seen a physician comp model that would do more to foster collaboration--and the ability to accept value-based payment--than the models commonly in use today? If so, please drop me a line. I'd love to hear what's possible. - Anne