Don Berwick, MD: Changing from fee-for-service to bundled payments in Medicare and Medicaid


  • By G Anstadt MD, April 19, 2012 @ 10:20 pm

    All payers pay “per click”, generally still without quality metrics. So, we get what we pay for… too many clicks, and low quality. Britain capitates care, limits supply of docs, and has a too little care problem; pay for performance 25% bonus is working well there. Bottom line; must pay for good outcomes, not clicks, at the individual provider, clinic, hospital system, and region levels. Start these integrated quality process incentive at the highest level, creating optimal health, not at first management of disease. The weakness of otherwise great Berwick work has been a focus on disease, not health. We know enough that very few should die of cardiovascular disease (rare at the turn of the 20th century!), but in our current non-system it is still the leading cause of death, a result not of a lack of knowledge, rather a lack of will and systems integration and proper incentives.

  • By Helmut Hildebrandt, April 21, 2012 @ 4:38 pm

    Bundled payment in my opinion is only the scond best solution, real integrated care with shared savings following the triple aim concept and orienting itself towards population health improvement is far stronger and more sustainable. We try something like this in a region in Germany with about 31,000 population. Look at www. and an english article under

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