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Special Communication
December 2014

Lowering Medical Costs Through the Sharing of Savings by Physicians and Patients: Inclusive Shared Savings

Author Affiliations
  • 1Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania
  • 2Center for Health Incentives and Behavioral Economics, Perelman School of Medicine, University of Pennsylvania
  • 3Department of Health Care Management, Wharton School, University of Pennsylvania

Copyright 2014 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Restrictions Apply to Government Use.

JAMA Intern Med. 2014;174(12):2009-2013. doi:10.1001/jamainternmed.2014.5367

Current approaches to controlling health care costs have strengths and weaknesses. We propose an alternative, “inclusive shared savings,” that aims to lower medical costs through savings that are shared by physicians and patients. Inclusive shared savings may be particularly attractive in situations in which treatments, such as those for gastric cancer, are similar in clinical effectiveness and have modest differences in convenience but substantially differ in cost. Inclusive shared savings incorporates features of typical insurance coverage, shared savings, and value-based insurance design but differs from value-based insurance design, which merely seeks to decrease or eliminate out-of-pocket costs. Inclusive shared savings offers financial incentives to physicians and patients to promote the use of lower-cost, but equally effective, interventions and should be evaluated in a rigorous trial or demonstration project.