Article

Segment 8 - Financial Incentives and Penalties

Panelists analyzed the concept of penalizing providers who deviate from pathway programs.

Panelists analyzed the concept of penalizing providers who deviate from pathway programs.

Dr Malin said rather than having a penalty, WellPoint chooses to incentivize behavior. When providers select treatments that are “off pathway,” they are reimbursed, but there are additional financial incentives for providers who select treatments that are “on pathway.”

Dr Yu agreed that incentives to change are preferable to penalties. He added that payers should not seek to penalize either— incentives should be determined internally from institutions or at the provider-group level.

Dr Nabhan said that by not achieving a certain pathway metric, a provider technically “penalizes” him or herself by missing the potential financial incentives that are available to them.

Newsletter

Stay ahead of policy, cost, and value—subscribe to AJMC for expert insights at the intersection of clinical care and health economics.

Related Videos
Nicolas Ferreyros, managing director, Community Oncology Alliance
Merrill H. Stewart, MD
David Awad, PharmD, BCOP
Merrill H. Stewart, MD
David Awad, PharmD, BCOP
Coral Omene, MD, PhD, sitting for a vieo interview
Coral Omene, MD, PhD, sitting for a vieo interview
David Awad, PharmD, BCOP
Screenshot of Coral Omene, MD, PhD
Eileen Peng, PharmD, sitting for a video interview
Related Content
AJMC Managed Markets Network Logo
CH LogoCenter for Biosimilars Logo