Payers and Patients: Searching for Value
July 12, 2013
The Patient Protection and Accountable Care Act of 2010 (ACA), with its host of changes, is often referred to as health reform. But it is not complete, having refrained from tackling one of the biggest policy challenges: payment reform. Many policymakers agree with the common observation that the goal should be to reward value, not volume. Public and private payers have taken steps in this direction by instituting pay-for-performance programs, in which providers are rewarded for meeting specified quality goals. Quality metrics abound, and yet no one is quite satisfied that measuring processes thought to be associated with better patient outcomes yields a true picture of the overall quality of care being delivered. Uncertainty about how to measure value is complicated by the difficulty of calculating the actual (versus the nominal or the negotiated) cost of a course of treatment. Pressure to deliver value is nevertheless building. This Forum session examined progress toward value-based purchasing and considered the decisions that health care stakeholders must weigh to move it forward.
Andrew Baskin, MD (bio)
National Medical Director for Quality and Provider Performance Measurement
Robert A. Berenson, Peter J. Pronovost, and Harlan M. Krumholz, "Achieving the Potential of Health Care Performance Measures," Robert Wood Johnson Foundation and Urban Institute, May 2013.