Clinical Pathways and Policy to Guard Against Misaligned Incentives

The application of clinical pathways and their enforcement through quality metric benchmark setting and appropriate use criteria is needed to guard against perverse financial incentives that encourage overutilization and underutilization. Moving forward, the more diligent payers and integrated delivery networks can be in evaluating and incorporating utilization criteria when establishing clinical pathways, the better off our system will be.

Our experts explore different payer policies and market dynamics that can result in the overutilization or underutilization of healthcare treatments. They also explore opportunities to mitigate the unintended consequences of previous policies, both through new Centers for Medicare & Medicaid Services (CMS) policy efforts and clinical pathway application. Because most spending in health care is funded by the government, CMS policies determine how most of healthcare funding is spent.

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“Clinical Pathways and Policy to Guard Against Misaligned Incentives”
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Author
Seth Gordon
General Manager

Seth’s deep understanding of the healthcare industry comes from more than 27 years of experience on both sides of the industry––pharmaceuticals and agency work. He has extensive product marketing and launch experience on both…

Dr. Richard Stefanacci
Chief Medical Director

Richard has focused his career on improving health outcomes, especially for some of the most vulnerable populations. This has been achieved through several avenues, beginning with his continued active role as a treating internist/geriatrician.…