A continuing shift in risk toward providers, as payers develop more reliable grouping algorithms and Medicaid and private-sector payers follow recent Medicare initiatives. This link has been notable by its absence so far, but developments in the measurement of quality can be expected to prompt experimentation with making payment depend on quality. These changes will have sweeping effects on how health care payment is made. Patterns of care will be affected as providers respond to changes in incentives. Though these changes carry the promise of increased efficiency and better outcomes, they may also lead providers to avoid expensive patients.
Past experience underscores the peril of counting on such a reduction, however.
Providers will face changed opportunities, with greater incentives to manage both the volume of care and the cost per service. Cost reimbursement and payment based on charges are all but dead as health care payment methods. Many providers, however, will benefit financially from bearing increased risk for the cost of care. Even with the changes in payment methods, health care will continue to be a major growth sector. A substantial side benefit will be increased understanding of health and health care made possible by better data.