It happened to the dot-coms. It happened to the banks.  

De Brantes notes the signs indicating healthcare is building up to a breaking point: spiraling costs that draw more and more from the national economy; increasing capacity; and lack of fear among providers that failure to produce value might put them out of business. 

The national attitude toward the value of medical care is changing, however. At some point, payers and providers will need to deliver quality or go out of business. 

P4P has chugged along for years, but local market dynamics have stalled the adoption of performance-based contracts, particularly where providers are in high demand. Typically, providers who participate are a small group of willing volunteers in markets where they experience competition, according to de Brantes. 

Even so, de Brantes has seen thousands of providers willing to step out of the broken market of the healthcare system and begin earning at least some of their income by delivering quality. National changes are inevitable, and he believes providers who cling to the status quo will be taken by surprise. 

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Healthcare market dynamics don't adequately drive quality, but that bubble will eventually burst, according to Francois de Brantes of Bridges to Excellence. Plans need to take more risks and upset the status quo.