How Carrots and Sticks May Break Our Bones—and the Bank

Aug 7, 2013, 1:00 PM, Posted by Michael Painter

Today, the Health Care Incentives Improvement Institute, Inc. (HCI3®) released “Improving Incentives to Free Motivation,” a report developed with support from the Robert Wood Johnson Foundation (RWJF), that makes a bold assertion: Financial incentives won’t fix our payment problems in health care.

In a guest post on The Health Care Blog today, I outlined why simply throwing more carrots and sticks at doctors and patients won’t improve the quality or affordability of our health care:

Until we get [the] human motivators right in health care, we can try all sorts of complicated, elegant payment models and formulas and still ultimately not get to the goal of sustainable high value. It will always be just over the horizon. Let's absolutely be smart about incentives in health care, but let's also get away from talking about simple carrots and sticks. Instead, let’s find the right mix of motivators to promote the creativity we need to get the best care every single time.”

The report calls for an alternate approach to payment reform that harnesses the inherent motivation that doctors and patients have to make good decisions about delivering and consuming health care. Its lead author and HCI3 executive director Francois de Brantes outlined this new framework in a Health Affairs guest blog today:

We suggest a different approach. The first step is to determine whether any given payment model has the potential to sap the health care professional's motivation to adhere to scientific evidence, to be the prudent steward of the patient's care, and to help the patient through the healing process. If it has the potential to create a negative charge on motivation, then change it."

The good news, as I wrote on The Health Care Blog, is that there is hope. And there are motivators more effective than dollars. It’s time we harness their power. We can’t afford not to.

This commentary originally appeared on the RWJF Pioneering Ideas blog.