Expert Urges Payment Reform, Stronger Oversight to Shift Care Toward Primary and Preventive Services

Elena Berube, a health services researcher at Dartmouth and former director of health systems finance and policy at the Green Mountain Care Board, told the Senate Health and Welfare committee that payment redesign and stronger market oversight are key tools to improve access to primary care and rein in health-care spending.

"The U.S. health care system is rife with market failure," Berube said, adding that misaligned incentives, poor information and limited competition drive wasteful spending and unequal access. She outlined how states and federal programs use a mix of payment approaches — capacity-based, activity-based (fee-for-service) and population-based (capitated) payments — and said Vermont needs monitoring and a suite of tools to manage the risks and benefits of each.

Berube framed the problem as a market-design issue: people and providers often face incentives that do not align with population health goals. She said that…