Pay-for-performance programs, which seek to better align incentives between insurers and clinicians, are increasingly being used to improve quality without necessarily increasing spending. For example, under Medicare’s hospital value-based payment program, reimbursements are based partly on hospital performance on measures of quality, satisfaction, and mortality rates.
We have not seen similar progress in reforming reimbursements for prescription drugs. Recent approvals of expensive medications targeting common cardiovascular diseases—including proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors, a new class of monoclonal antibody lipid-lowering therapy—provide an opportunity to use innovative reimbursement approaches to foster better accountability for patient outcomes.
Blumenthal DM, Goldman D, Jena AB. Tying Reimbursement to Outcomes Is an Ideal Strategy for PCSK9 Inhibitors. JAMA Cardiol. 2017;2(10):1063–1064. doi:10.1001/jamacardio.2017.2959
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