The incentives pull in opposite directions — fee-for-service to deliver more services for sick patients, bundled payments to be efficient and keep patients healthy.
"We are clearly gearing up to change directions from fee for service for what I'll call payment for value," said Will Groneman, an executive vice president for TriHealth, one of the systems.
John McAleavy, directions of operations at Edison Learning, said they would "of course" be interested in running schools under the management fee system.
The costs will be centrally covered by the SCOAP3 consortium through a process of reduction and re-direction of subscription fees.
The first ferry service had ten different route combinations in each direction, and the fees were based on three different zones.
Even just the threat of steering us in that direction could help keep fees down.
Arthur acknowledged there would be "forces in the other direction" that might push fees down, such as competition between universities.
But when it comes to in-flight Internet, some airlines are moving in the opposite direction from charging additional fees, at least for now.
Our direction of travel is putting fees down to £6,000, not putting them up, but we've still got to set that out.
