Authors Call for New Culture of Shared Accountability for Medicare's Merit-based Incentive Payment System

March 5, 2019

Adam S. Wilk, PhD, assistant professor of health policy and management at the Emory Rollins School of Public Health, is first author on an article published in The American Journal of Accountable Care that argues Medicare’s Merit-based Incentive Payment System gives too little consideration to the impact of social determinants of health on population health outcomes. Sanjula Jain, PhD, of The Health Management Academy, is a co-author on the paper.

The authors write the fact that individual providers are being held accountable for population-level health outcomes over which they have limited control has been underappreciated by the policy makers formulating Medicare’s value-based payment systems. This has resulted in a misalignment of accountability and capability that defers population health improvements.

“Everyone aspires to well-coordinated, population health-oriented systems of care in our communities,” says Wilk. “But we are asking a lot of individual clinicians or even most larger provider organizations when we hold them accountable for improving outcomes that can only really be addressed through well-implemented public health and social services programs. Some of the payment reform initiatives underway underappreciate the scope of the interventions needed to improve population health.”

Using the examples of major depressive disorder and antidepressant medication management as a lens, the authors write that payment reform efforts are too imprecise to drive significant improvements in population health care delivery when health care providers act independently. They stress that these efforts will only be effective if medical service providers can better coordinate and integrate with nonmedical service providers. 

The authors call for a “new culture of shared accountability,” one in which individual providers and their organizations understand and accept their roles in population health improvement and work to support each other in those roles. At the individual clinician level, for instance, this means refocusing quality measures on services that physicians actually provide, like depression screenings, rather than outcomes further downstream, like antidepressant medication management. Additionally, there must be collaboration and commitment among health care organizations and community partners, including social service providers and payment models that reward providers who make these efforts.

“Evaluation throughout these efforts is essential for sustaining and expanding on these efforts too,” says Wilk. “When a community figures out how health care organizations can engage in these relationships effectively and can demonstrate rigorously how it works, that will sustain buy-in among payers locally and also give other communities a chance to learn and adopt best practices.”