Higher Stakes for Physicians and Patients
Figure 1. Higher Stakes Require Higher Rigor
Tiered or Limited Networks
Consumer-Directed Health Plans
Public Reporting of Performance
Physician Pay-for-Performance
Quality Improvement Programs
Higher Accuracy and Methodological Rigor Required
Figure 2. The Win–Lose Cycle
Develop mechanisms to reduce costs.
Practitioners seek loopholes, alternatives.
Providers withhold innovations, ideas.
They spend time imagining how to beat the system.
No feedback loop. Costs dip briefly, then escalate.
Source: H. B. Beckman, Rochester Individual Practice Association, Mar. 2004.

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