Perspectives

Moving Away from Fee-for-Service: Implications for Medication Adherence

Authors: Michael E. Farhangian, BA, Steven R. Feldman, MD, PhD

Abstract

As part of the Patient Protection and Affordable Care Act (PL 111–148), the US Congress has required that the Centers for Medicare & Medicaid Services implement pay-for- performance programs in which reimbursement will be tied to patients’ treatment outcomes. Pay-for-performance models are an attempt at controlling healthcare costs while concurrently trying to improve the quality of the care that is delivered. This is a departure from the current system of fee-for-service, in which payment is based on the amount and type of care provided, and from capitated systems, in which payment is based on the number of covered lives; in each of these systems, payment may be independent of outcomes. Paying for results would change the financial incentives for healthcare providers; rather than putting the financial incentive on providing more care in fee-for-service or less care in a capitated model, paying for results aligns financial incentives to providing “better” care, at least in an ideal world.

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