What They’re Watching: Nick Macchione on paying for performance

Nick Macchione is the Director of San Diego County HHSA. He joins us in this edition of “What They’re Watching” to talk about paying for performance.

There’s a lot of discussion about our whole movement from volume to value or the social impact bonds, there’s a whole lot of interesting financing models. but I think we have to go back to the core and we often sometimes forget with all the noise and things going on, that for governments like Health and Human Services and typically governments up and down the state, we do cost reimbursement.

And I think we don’t have to be more novel than ourselves to say, how much of that can we shift to do more pay for performance? How do we make it less burdensome for our business partners who we contract with to really judge them by hitting the outcomes and ensuring in this case HEDIS [Healthcare Effectiveness Data and Information Set] measures or housing placement measures, or getting people who are homeless off the streets and successfully housed, or getting someone through a drug treatment, or getting a kid in foster care in a forever home.

Point is, it’s the outcome that matters most for us that we’re measuring about how we’re driving wellness. So, we’re moving and we’re trying at a local level of trying to move more of our procurements from a cost reimbursement to where it makes sense to a pay for performance model.