Meanwhile, get thyself a profile pic in Disqus, the unblinking stare of that box does you a disservice!

It's of course true that the law of large numbers is important if you're trying to measure something that needs big numbers for the metric to work, but at the end of the day, the whole set of assumptions is wrong.

Yes, there are things that can and should be measured on the basis of a population. But care gets delivered to individuals, and quality happens at that level. Unfortunately, most P4P programs are conflating these notions to the detriment of care. It's like using Newtonian physics to predict quantum events, or something like that!

The same argument of 'law of large numbers' applied in the 90s as more and more health plans looked to capitate risk bearing entities whether medical groups, IPAs or joint venture PHOs. The fatal flaw was the inability, from a cost and utilization perspective, to align the behavior of the enrolled members with the actuarial projections of the well compensated benefits consultants. The net was massive losses particularly in those entities lacking membership scale and thus a reasonable mathematical expectation of real world events to conform with 'expected'.

We wight caution the P4P appeal with a similar practical hedge. Yet, we must redesign the failed financing and delivery paradigms in this country and can not let legitimate considerations derail forward movement.