Forum Session

Seeking Value in Medicare: Addressing Quality and Cost
November 22, 2013


Lisa Sprague, MBA


In pursuing a shift to paying for value rather than volume, the U.S. Department of Health and Human Services (HHS) has undertaken a range of activities designed to assess quality in the Medicare program. Some, such as the National Strategy for Quality Improvement, are quite broad-based. Others are targeted specifically by provider type. What were at one time pay-for-reporting programs for hospitals and doctors have become value-based purchasing (VBP) programs that take into account patient experience and cost as well as clinical quality, with financial consequences to providers. Hospitals received their first VBP payment adjustment in late 2012; physician VBP payment adjustments will roll out beginning in 2015. Whether VBP can fulfill its aspirations of better care for lower cost and system transformation remains to be seen. This Forum session explored the development of VBP, the challenges the Centers for Medicare & Medicaid Services (CMS) has faced in implementing it, and the ways in which CMS's actions can dovetail with and even advance private-sector initiatives in delivery system and payment reform.


Patrick Conway, MD, MSc (bio)
Deputy Administrator for Quality and Innovation
Director, Center for Medicare and Medicaid Innovation
Director, Center for Clinical Standards and Quality
Chief Medical Officer

Centers for Medicare & Medicaid Services

Susannah Bernheim, MD, MHS (bio)
Director, Quality Measurement
Center for Outcomes Research and Evaluation
Yale-New Haven Hospital
Clinical Instructor
Yale University School of Medicine


Related Materials

See also "Seeking Value in Medicare: Performance Measurement for Clinical Professionals" (Issue Brief No. 852, October 30, 2013).

For more information about value-based purchasing beyond Medicare, see the slides from a presentation by David Lansky, PhD, to the Forum session "Payers and Patients: Searching for Value" (July 12, 2013).

For a discussion of the issues involved in performance measurement, see Robert A. Berenson, Peter J. Pronovost, and Harlan M. Krumholz, "Timely Analysis of Immediate Health Policy Issues: Achieving the Potential of Health Care Performance Measures" (Robert Wood Johnson Foundation and the Urban Institute, May 2013, p. 1) .

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