Agree 100% on this. The incentives in a fee-for-service world are just so badly misaligned with the goals of functional healthcare system.
> Even the value based programs that CMS has implemented are really fee for service with a look back and adjustments to payments made based on savings that were encountered.
So CMS is acutely aware that merit-based adjustments on top of a fee-for-service model is an incremental improvement (and a very modest increment at that). So within the Medicare's Quality Payments Program, there is MIPS (Merit-based Incentive Payment System) which is exactly what you describe and where most providers default to right now. But there are also several APMs (Alternative Payment Models) that providers can elect to participate in, some of which have full or partially-capitated payment mechanisms where there is a fixed fee per beneficiary, rather than the fee-for-service model. Everything I've heard from CMS suggests that APMs are the future and fee-for-service needs to go away. That's not going to happen over night but MIPS is the narrow end of the wedge to get us there.