Rewarding health care organizations for large-scale improvement will help accelerate improvement in care and quality

Rewarding health care organizations for achieving large-scale, population-based improvement has significant potential to accelerate the spread of evidence-based interventions, improve quality, and control costs at a national level, according to a commentary in the February 17 issue of the Journal of the American Medical Association.

Keith Mandel, M.D., Vice President of Medical Affairs of the physician-hospital organization at Cincinnati Children's Hospital Medical Center, asserts that linking rewards to aggregate performance across health care organizations promotes shared accountability for improving care, enhances leadership focus on large-scale change, and fundamentally alters how sites interact and learn from each other.

Dr. Mandel proposes a new model for rewarding health care organizations, such as primary care practices and hospitals: a key design characteristic is that rewards at the organizational level are contingent on first achieving designated thresholds for aggregate-level performance. He recommends testing this approach with large-scale improvement initiatives at the regional, state, and national level.

Too often, Dr. Mandel argues, incentives for improvement promote competition among health care organizations. But if the goal is to improve care across large populations, new models that promote cooperation and shared accountability are needed.

"Aggregate-level incentives shift the focus to population-based performance and shared learning across sites, thus accelerating the spread of what works," Dr. Mandel writes. "Health care organizations, such as primary care practices and hospitals, can still compete on quality and cost; however, promoting shared accountability for improving population-based measures through aggregate-level incentives changes the rules."

Dr. Mandel emphasizes the importance of more strategically leveraging current and future investments to accelerate large-scale improvement, and contends that "if success is truly defined as achieving population-based improvement, why not align at least a portion of rewards with achieving this overall aim?"

Additional information can be found at www.cincinnatichildrens.org.