>rewards health outcomes rather than required activities… earn the full amount only when patients meet measurable health goals, like lower blood pressure or reduced pain

They’ll just start cherry picking their patients, finding ways to squeeze out the people just that little bit lower on the prognosis curve. Or at least that will be the risk in a setup like that.

That's the biggest risk. I can also imagine it encouraging a certain kind of fraud.

The program sounds reasonable until you become aware that the patients most in need are often the ones least likely to improve. It also ignores the reality that sometimes even the most rigorous, well reasoned treatment plans fail for unpredictable reasons. Do you punish providers and patients for that?

One might argue that that's the goal. There's the approach we've taken of trying to help people, and then there's the approach some people want, which is to treat every problem as if it is an entirely individual problem and treatment has to be earned by trying to will yourself out of the problem.

You see upcoding in risk-based programs already too (like Medicare Advantage). It's trivial to say a patient is sicker than they are and then let them "miraculously improve".

Real bummer.

This recent article about Outcome Aligned Payments in the Journal of the American Medical Association (JAMA) explains how they mitigate cherry-picking: https://jamanetwork.com/journals/jama/fullarticle/2848799?gu...