Using Innovative Payment Models to Drive Improvement in Perioperative Care

Spending on perioperative care is estimated to be more than 30% of all US spending on health care and prevailing variations in spending and clinical outcomes suggest inefficiencies in care delivery and significant opportunities to reduce spending and improve health outcomes. Payment models may impact the quality and quantity of care across the five phases of the surgical continuum (i.e., preoperative, perioperative, intraoperative, postoperative, and functional recovery). Thus providers should not only understand payment models as they are being discussed and implemented but should seek to provide input to limit unanticipated consequences, spillover effects, and ultimately improve the value of care delivered to patients. Understanding the basic design of payment models is necessary to take advantage of new opportunities to improve perioperative care. All payment models fundamentally seek to leverage financial incentives for healthcare organizations, providers, and patients to drive behavior changes that reduce spending on healthcare services and improve health outcomes. Contemporary payment models now increasingly mandate providers or healthcare organizations to assume accountability for the costs and outcomes associated with services delivered. Characterized as “financial risk,” such payment models provide an opportunity for additional revenue and for exposure to potential losses. Success in these payment models depends on the ability of providers and healthcare organizations to deliver services efficiently, improve coordination of care across providers and treatment settings, improve health outcomes, and monitor use and costs of care. In this chapter, we review several payment models with provider-focused and patient-focused incentives, including evidence supporting these models and practical implications for providers to consider when participating in each type of model.