Incentive payments: the correct lesson

Lavergne and colleagues found that incentive payments to primary care physicians for the care of patients with complex disease had no impact on health care outcomes.1 That’s an important finding, but the wrong lesson is easily drawn from it.

The correct lesson is not that incentives do not work, but that incentives alone do not work. The key is contained in the first paragraph of their methods section: “British Columbia retained the fee-for-service payment system and made no structural changes to primary care provision, such as the introduction of team-based models of practice.”1 Our team studied the introduction of incentive payments statewide in Michigan and found substantial reductions in presentation to emergency departments, admission to hospital and cost.2 However, that incentive program was implemented with explicit ties to the medical home model. It also included supports such as learning collaboratives to aid practices in transformation.

Incentives are necessary, but they’re not sufficient. This point must be made clear to policy-makers, lest they make the error of discarding incentives rather than connecting them to the structures needed to make them work.