title: The evolution of financial incentives in the U.S. health care system.
abstract: The U.S. health care system continues to evolve toward value-based payment, rewarding providers based upon outcomes per dollar spent. To date, payment innovation has largely targeted primary care, with little consideration for the role of surgical specialists. As such, there remains appropriate uncertainty surrounding the optimal role of the urologic oncologist in alternative payment models. This commentary summarizes the context of U.S. health care reform and offers insights into supply-side innovations including accountable care organizations and bundled payments. Additionally, and importantly, we discuss the implications of rising out-of-pocket health care expenditures giving rise to health care consumerism and the implications therein.
authors.affiliation: Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, TN.
authors.forename: Annie L
authors.initials: AL
authors.lastname: Darves-Bornoz
authors.affiliation: Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, TN; Department of Health Policy, Vanderbilt University Medical Center, Nashville, TN; Department of Geriatric Research and Education Center, Tennessee Valley VA Health Care System, Nashville, TN. Electronic address: Matthew.Resnick@vanderbilt.edu.
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Resnick
mesh_terms: D060866:Accountable Care Organizations; D003258:Consumer Behavior; D017281:Cost of Illness; D003695:Delivery of Health Care / Q000191:economics*; D018588:Fee-for-Service Plans / Q000191:economics / Q000639:trends; D018166:Health Care Reform / Q000191:economics; D005102:Health Expenditures / Q000639:trends; D006801:Humans; D012052:Reimbursement, Incentive / Q000639:trends; D014481:United States; D014572:Urology
keywords: Accountable care organizations; Bundled payments; Health care costs; Health care financing; Health care quality; Health care reform