National payment rate could improve healthcare value

To establish a truly value-based system, the healthcare industry must establish a national payment rate based on the nation's top providers' care costs, argues a Health Affairs blog post.

Payment mechanisms such as fee-for-service have their advantages, but the best payment systems to advance healthcare in the direction of true value are global-based ones such as bundled payments and full capitation, write the authors. To succeed in promoting high-value care, such models must feature several key elements, including:

  • Payments based on reality: Abstract formulas often prove incorrect in practice or reward poor outcomes. Instead, the post states, providers must calculate the cost over time of delivery at the care organizations with the best care outcomes. Such an adjustment will be difficult for organizations with higher-than-average costs, which would take a pay cut, so providers must phase in payments over a three-year period, the post states.
  • Per member per year reimbursement and bundled payments: Such payments, the authors add, must also be adjusted for population characteristics and its risk. "A risk-adjusted quality component/withhold is warranted to ensure that we do not sacrifice care effectiveness in the name of efficiency, i.e., patients are not denied appropriate care," the post states.
  • Patient engagement: Providers must align payment approaches and payment benefits to make sure patients have a say in the matter, according to the post. The payment overhauls must begin in the areas of highest need, i.e. a highly complex patient population that accounts for the majority of healthcare costs. Organization can first target these populations specifically rather than introducing them to the broader patient population all at once, according to the post.

To learn more:
- read the post