Although the idea of paying hospitals, physicians and other care providers for defined episodes of care makes intuitive sense, working out the details of how to do so is not for the faint of heart.

In the current issue of Health Affairs, RAND researchers point out the key problem with episode-based payment: the fragmented nature of the health care delivery system:

The array of trajectories a patient could take through the health care system—potentially touching multiple providers located in different settings—highlights the challenges of delivering coordinated care. Medicare beneficiaries receive care from a median of seven physicians,5 and the typical primary care physician must coordinate with 229 other physicians working in 117 practices.6 Typically, no single provider or set of providers claims responsibility for managing a patient’s care from the start to finish of a care episode. Episode-based approaches seek to remediate these problems by strengthening incentives for greater coordination among the array of providers involved in a patient’s care.

Check out their analysis of the research that needs to be done and the consensus-building that must occur before episode-base payment can occur.