What do merit pay for teachers and pay-for-performance (P4P) for physicians have in common? Both may lead to “teaching for the test.”

A recent study of almost 500,000 patients in the British health system found no evidence that P4P benefited patients with hypertension. Another study found that P4P may exacerbate, rather than improve, health disparities. While the evidence is mixed, it seems clear that P4P by itself is unlikely to transform the health care system and runs the risk of incentivizing doctors and hospitals to “test for the test” and focus on particular processes/outcomes identified by payers and the new health care legislation rather than the “whole” patient and comprehensive outcomes.

That said, the emphasis on more tightly drawn algorithms of care, accountable care organizations and bundled payments is likely to include a greater emphasis on meeting both process-and outcome-oriented measurements of care. Agreeing on the measurements is one thing, but open and transparent communication between patients, providers and payers – and having the right incentives in place to form a cohesive and committed health care team – is another matter entirely.