Discussion Topic 2

Incentives bring to mind the expression "gaming the system." This case simplifies the expression to "gaming incentives." Same thing. There are a few ways to define it, but the one that fits into the territory we've gotten into with this case study and the questions to follow are specific to the choices made for short-term benefit at the cost of long-term gain. Example? I remember a promotion run by either Pepsi or Coke over 20 years ago, where the bottle tops of any number of their bottled drinks were essentially coupons for a free like-sized purchase. And you know what? If you held the bottle at a particular angle, you could see the bottle tops that had the language for a free drink and go reap the spoils. You've gamed the system to get the free drink (short-term) to the potential sacrifice of your health by way of any combination of increased body mass index (BMI), blood pressure (BP), and other comorbidities that would be influenced by excessive fizzy drink.

Many incentives in healthcare function much the same way, in that they don't necessarily align the choices you make today with the choices you make tomorrow. Some healthcare related incentives for patients and/or providers I am aware of include:

1. For providers, an incentive for their diabetic patient panels to have good A1C levels. What's great about this one is it continues to incentivize good control regardless of time horizon.
2. For members, a age-defined female population is incentivized via gift cards to receive women's health services including but not exclusive to mammograms, pap smears, and chlamydia screenings.

What's the difference between the provider incentive and the member one? Time horizon. Providers are rewarded to work with their patient's in maintaining acceptable A1C measurements. While the patient isn't a direct recipient of that financial kick, they are a recipient of the health-related benefits that proper blood sugar levels yield.

Though my member incentive selection is a bit different. It's one thing to get the screenings ... but following up on abnormal results isn't captured here. Whether there's a suspicious mass in a mammogram or chlamydia screening comes back positive, treatment is not a base covered by measure of the gift card. This avoids a slippery question of only members with adverse results would be rewarded, and healthy not.

Here are some questions straight from the case that I'd like your input on. For full credit, step one involves you writing your own original response to each question in one post. Step two is to review feedback from your classmates and respond to one whose input has altered your original interpretation and related answers. In other words, stay away from the posts you agree with and look for the ones you don't. Now for the questions:

2. How can hospital CEOs design appropriate incentives for surgeons, whose expertise and skill is difficult to externally verify?