U.S. payment systems tend to reward volume-driven rather than value-driven care. Providers respond to incentives to deliver more, and not necessarily better, care.

That’s the thesis of a new report from the Robert Wood Johnson Foundation that analyzes the financing of American health care delivery and provides recommendations to improve that system, rationalize spending on what works, benefit patients, and conserve wasted spending.

To get to those recommendations, From Volume to Value: Transforming Health Care Payment and Delivery Systems to Improve Quality and Reduce Costs examines several key dimensions of how to align the mis-aligned payment structure of U.S. health care:

  • Providers’ willingness to accept new payment structures that address value-based care
  • How to encourage the use of high-value providers and services be encouraged
  • How to ensure appropriate quality for patients
  • How to encourage both payers and providers to participate in new payment and delivery systems
  • Whether payers’ systems for reimbursing care need to be similar or whether they could be heterogeneous
  • Types of pilot projects to test the different approaches
  • What’s needed in communities to foster payment reform.

RWJF and the Network for Regional Health Care Improvement (NRHI) brought 100 health care leaders from throughout the U.S. together to wrestle with these questions. The group developed a broad range of recommendations, such as:

  • Supporting innovations in primary care payment (think: patient-centered medical home, for example)
  • Bundle payments to provider groups to manage the entire episode of care, instead of paying for episodic visits and inpatient admissions
  • Provide consumers with intelligent, actionable and useful information that help them make informed choices toward the best quality providers in their communities
  • Payment structures should favor providers who adopt evidence-based practices in patient care based on specific disease states and conditions
  • Pilot programs should be developed that are practical and, once proven, should have migration strategies that take the best practices to market a.s.a.p.
  • and many others.

Health Populi’s Hot Points: The plethora of evidence presented in the past several years from RWJF along with the Commonwealth Fund, the Center for Studying Health System Change, and countless research reports published in Health Affairs have pointed out that the mis-aligned payment systems in the U.S. have caused the nation to (1) spend more money on health care per citizen than any other nation in the world, and (2) to achieve poorer health outcomes than most developed nations in the world.

Those of us who watch this space have recognized that it’s this mis-alignment of incentives that’s got us to this state of a health economy that’s cost-increasing, quality-quashing, labyrinthine and cumbersome for consumers to navigate.

Feel better now that we all recognize this reality?

What’s going to get us to ‘yes’ in terms of payment reform is for all participants in the system to come together and ante up what they can to make these adaptations. Who are these stakeholders? Providers, payers, government agencies (Federal and State), suppliers, technology developers, and citizens: parents, children, patients, caregivers.

So to get to realignment of payment systems, each one of these players will have to change behavior, grow and stretch new muscles in a new kind of health system that rewards providers based on what works. The recommendations of the RWJF/NRHI report encompass these sorts of behavior changes. Adopting them will, ultimately, culminate in improving Americans’ health. By doing that, we’ll also improve the health of the American economy.

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