Opinion Piece: Rethinking Healthcare Profit: Toward an Accountable Model

The U.S. healthcare system is often described as too capitalistic — and not without reason. Health insurance CEOs earn tens of millions while everyday Americans are denied services and procedures while juggling increasing costs of prescription drugs with climbing costs of monthly premiums. While America is a capitalistic nation, we really should take time to reevaluate healthcare as a niche industry that runs quite differently than other businesses, and requires deeper understandings and considerations. Our current approach isn’t just unsustainable — it’s unethical. But the answer isn’t to eliminate profit altogether. Instead, we need a middle ground: Accountable Profit Healthcare.

I realize this is a new term/concept I have created, so I am offering a definition for it here:

Accountable Profit Healthcare is a model of healthcare delivery that allows for reasonable profits but ties executive compensation and organizational rewards to patient outcomes, equity, and quality of care. Under this system, caps may be placed on excessive salaries, and bonuses are tied to value creation for patients — not just cost-cutting. It embraces innovation and efficiency while prioritizing public health and ethical responsibility.

This could also be termed, “Shared Outcome Healthcare” that is more of an equity-tied capitalism goal. 

In this model, healthcare organizations can still earn profits, but only within ethical bounds. Executive compensation would be tied not only to financial performance but also to patient outcomes, equity, and access. We already do this with providers who can receive bonuses for quality care and this just extends a similar matrix to hold administrators to similar standards. We don’t need to swing fully into socialized medicine to create change. We can build a better system where profits serve people — not the other way around. Accountable Profit Healthcare offers a balanced, values-driven path forward.

In order to achieve this kind of change, we need clear, measurable quality indicators for healthcare administrators and executives, just like we do for providers.

Below is a list of quality-based pay measures for health administrators that align with patient-centered care, organizational performance, ethical delivery, and cost transparency. These can be structured into bonus frameworks, salary adjustments, or public accountability metrics.

Below are some examples that could be considered:

Quality Pay Measures for Health Administrators

1. Patient Outcomes & Safety

• System-wide improvement in HEDIS scores, readmission rates, or infection rates related to policies against early discharge based on individualized risks such as age, patient location/ situation, and comorbidities
• Reduction in preventable adverse events (falls, medication errors, hospital-acquired infections) via administrative support in tracking and using suspecting analytics to identify patients at higher risks
• Patient mortality trends adjusted for risk across service lines

2. Equity & Access

• Reduction in racial/ethnic disparities in care delivery or outcomes through equitable policy and procedure and addressing SDOH in this area
• Improved access to care for underserved populations (measured by patient wait times, availability of appointments, transportation solutions) via partnerships and methods to support clinicians delivering care
• Implementation of community outreach initiatives or mobile care units with budgets to support SDOH

3. Patient Satisfaction & Experience

• Improvement in HCAHPS or CAHPS scores
• Complaint-to-resolution turnaround time
• Digital feedback mechanisms in place and acted upon

4. Clinical Documentation & Coding Integrity

• Accuracy of risk adjustment coding, tied to valid documentation (reduction in upcoding, audit reversals)
• Timeliness and accuracy of CDI programs led at the administrative level, understanding that CDI for claims accuracy is a separate exercise from population health data collection

5. Workforce Health & Satisfaction

• Staff retention rates, especially for nurses and frontline workers
• Staff satisfaction surveys and follow-up improvement plans
• Reduction in clinician burnout scores (via tools like the Maslach Burnout Inventory)

6. Financial Transparency & Ethical Practices

• Cap on administrative costs as a percentage of operating revenue
• Transparent annual reporting of executive compensation vs. median employee salary (publicly available)
• Use of profits toward care reinvestment (e.g., % of profit reinvested into infrastructure, staff education, or community programs)

7. Operational Efficiency Without Harm

• Reduction in low-value care spending (measured using Choosing Wisely or similar guidelines)
• Use of predictive analytics and data to reduce unnecessary testing/hospital stays
• Timeliness of claims processing and appeals resolution

8. Innovation That Benefits Patients

• Implementation of new tech or AI that improves outcomes or access
• User-centered design adoption for digital portals or appointment systems
• Reduction in patient medical debt burden or surprise billing complaints

Here are further examples of a scorecard markup and a dashboard that could be implemented:

Quality Pay for Health Administrators: Sample Scorecard & Dashboard

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1. Administrator Quality-Based Pay Scorecard Example
For Internal Use – Tracks Annual Executive Performance

Measure Category	Specific Metric	Weight (%)	Target	Actual Performance	Score (0-5)	Notes
Patient Outcomes & Safety	30-day readmission rate reduction	15%	-5% from last year	-6.2%	5	Target exceeded
	Reduction in hospital-acquired infections (HAIs)	10%	-10%	-7.5%	4	Moderate improvement
Equity & Access	Increase in access for Medicaid patients	10%	+15% appointment slots	+10%	3	Needs improvement
	Implementation of rural telehealth expansion	5%	Launch by Q3	Launched Q2	5	Ahead of schedule
Patient Satisfaction	HCAHPS composite score improvement	10%	+2 points	+1.8	4	Nearly met
Workforce Well-being	Staff retention rate improvement	10%	+8% over baseline	+6%	3	Partial progress
	Clinician burnout reduction (survey-based)*	5%	15% decrease in burnout	17% decrease	5	Target exceeded
Financial Ethics	Cap admin costs to <12% of total operating revenue	10%	12% or lower	11.8%	5	Achieved goal
	Publish executive salary ratio vs. median worker publicly	5%	Publish by Q2	Q1 publication	5	Exceeded
Operational Efficiency	Reduce low-value care usage per Choosing Wisely standards**	10%	-10%	-9.4%	4	Near target
Innovation	Launch AI-driven claims analytics tool	5%	Pilot by Q4	Pilot in Q3	5	Early implementation
TOTAL		100%

 

*Burnout measured via Maslach Burnout Inventory (MBI): A validated tool assessing emotional exhaustion, depersonalization, and personal accomplishment. For more info: Frontiers

**Choosing Wisely: An initiative of the ABIM Foundation to reduce low-value care through evidence-based guidance. See: JAMA.  Choosing Wisely

Score Interpretation:

• 4.5–5.0: Exceptional performance; eligible for full bonus
• 3.5–4.4: Strong performance; partial bonus
• 2.5–3.4: Needs improvement; consider coaching
• Below 2.5: Unsatisfactory; not eligible for bonus

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2. Executive Quality Performance Dashboard Example
For Public/Board Reporting (Quarterly)

Category	Status	Notes / Key Updates
Patient Safety	✅ On Track	HAI rate down 7.5%; readmission goal exceeded
Health Equity	⚠ Needs Work	Medicaid access +10%, short of 15% target
Patient Satisfaction	✅ On Track	HCAHPS up 1.8 points; provider bedside manner scores up
Workforce Well-being	✅ Strong	Staff burnout decreased 17%; HR exit interviews improved
Financial Ethics	✅ On Track	Admin cost at 11.8%; salary transparency published
Operational Efficiency	✅ On Track	Low-value care decreased by 9.4%; improving data use
Innovation	✅ Exceeding	AI claims tool launched in Q3 ahead of schedule

Legend: ✅ On Track ⚠ Needs Work ❌ Off Track

 

While I proudly carry a certification in clinical bioethics from Georgetown, and believe this idea is actionable for administrators of health systems and facilities as well as issuers, there are doctorate level professionals in clinical bioethics who could massage this concept in more depth. We should be using them more often in healthcare delivery in general as advisors.

 

Additional References:

1. Maslach Burnout Inventory (MBI): The Maslach Burnout Inventory (MBI) is a widely recognized tool for assessing occupational burnout. It evaluates three dimensions: emotional exhaustion, depersonalization (or cynicism), and reduced personal accomplishment. The MBI has been validated across various professional groups and settings.   Oxford Academic. Biomed Central  Wikipedia.

• Validation Study: A study published in BMC Health Services Research assessed the 9-item version of the MBI-General Survey (MBI-GS9) among care aides in Canadian nursing homes. The study found that the MBI-GS9 exhibited acceptable psychometric properties, demonstrating its reliability and validity in this context. ​
• Comprehensive Review: An article in Frontiers in Psychology discusses the extensive validation of the MBI over the past 35 years, highlighting its widespread use and the development of alternative versions for different occupational groups.
• Historical Perspective: The original development and conceptualization of the MBI are detailed in a 1981 article by Maslach and Jackson, which laid the foundation for subsequent research and application of the inventory. ​

2. Choosing Wisely Campaign

The Choosing Wisely campaign, initiated by the American Board of Internal Medicine (ABIM) Foundation, aims to promote conversations between clinicians and patients about unnecessary medical tests, treatments, and procedures. It encourages evidence-based decision-making to reduce overuse in healthcare.​  Nature Medicine     Wikipedia    PubMed   ABIM   PubMed   NEJM   AMA Journal of Ethics.

• Global Perspective: An article in the Journal of General and Family Medicine discusses the international adoption of Choosing Wisely campaigns, emphasizing a shared approach to tackling the problem of overuse in healthcare across different countries.

• Campaign Overview: The official Choosing Wisely website provides comprehensive information about the campaign’s goals, history, and resources for both clinicians and patients. It outlines the initiative’s efforts to reduce unnecessary care and improve patient outcomes. ​

• Impact Assessment: A review in JAMA Health Forum reflects on the first ten years of the Choosing Wisely campaign, evaluating its successes and challenges in reducing low-value care and influencing clinical practice.