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Redesigning provider payment: Opportunities and challenges from the Hawaii experience

机译：重新设计提供商付款：夏威夷经验的机遇和挑战

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摘要

Objectives: To describe the process of developing a new physician payment system based on value and transi-tioning away from a fee-for-service payment system. Study design: Descriptive. This paper describes a recent initiative involving redesign of primary care provider payment in the State of Hawaii. While there has been extensive discussion about switching payment from volume to value in recent years, much of this change has happened at the organizational level and this initiative focused on changing the incentives for individual providers. Methods: Descriptive paper. In this paper we discuss the approach taken to shift incentives from fee-for-service towards value using behavioral economics as a conceptual framework for program design. We summarize the new payment system, challenges in its design, and our approach to piloting of different behavioral economic strategies to improve performance. Results: None. Conclusions: This paper will provide useful guidance to health plans or health delivery systems considering shifting primary care payment away from fee-for-service towards value highlighting some of the design challenges and necessary compromises in implementing such a system at scale.
机译：目标：描述基于价值和转发的新医师支付系统远离服务费用支付系统的过程。研究设计：描述性。本文介绍了最近涉及在夏威夷州重新设计的初级护理提供商付款的举措。虽然有关近年来从卷转换到价值的批准的广泛讨论，但在组织级别发生了大部分情况以及该计划的重点是改变各个提供商的激励。方法：描述性纸张。在本文中，我们讨论了使用行为经济学作为计划设计的概念框架来转移促进奖励措施的方法。我们总结了新的支付系统，设计挑战，以及我们驾驶不同行为经济策略的方法，以提高性能。结果：没有。结论：本文将对卫生计划或健康送货系统提供有用的指导，考虑将初级保健支付远离服务费，以突出一些设计挑战和必要的妥协在规模上实施此类系统。

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