Essentially, this list requires wonks to question whether the program's measures reflect real patient outcomes or are mere "proxies" that poorly correlate with improved patient health, and whether the infrastructure exists to distribute the awards.

For the list, policymakers should make sure that changed behavior will improve patient outcomes; that clinicians' behavior isn't already changing without the program; that there are reliable ways to measure the behavior change; that any barriers to the change have been identified; that financial incentives are known to work better than auditing and feedback or other approaches; and that the benefits outweigh unintended harms, such as discouraging doctors from seeing high-risk patients or encouraging rewards gaming.


If most of these conditions aren't met (especially the first two), planners should go back to the drawing board, according to the researchers. However, if they work, the organizers then have to figure out how to get a structure in place to implement the program, decide on a payment plan and work out financial delivery.

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