Payment and delivery reform are essential to containing costs in the U.S. health care system while addressing the need for improved quality. These efforts are directed at both the demand-side (patients and employers) and the supply-side (payers, physicians, clinical organizations), and the success of future reform relies on the evaluation of current and prior experiments to improve value. However, most of this experimentation has been piecemeal and voluntary, embedded in widely varied local environments usually characterized by competitive insurance, hospital, and medical service markets. So, while the Affordable Care Act of 2010 seeks to promote the most promising innovations, little is known generally about what the most effective supply-side strategies are, how ready payers and providers are to implement changes, or what policymakers should expect from ACA initiatives. This paper summarizes key points from an expert panel AcademyHealth convened to identify how the knowledge from existing research can inform policy development and implementation in this area. The meeting discussion covered a range of supply-side strategies to improve value, including: Accountable Care Organizations (ACOs), bundled, capitated, and performance-based payment, and guideline- or education-based initiatives. During the meeting, the need for more precise performance measurement and better data emerged as key issues for successful payment reform efforts. Participants also noted that prior delivery system reform has largely occurred in receptive environments that were well-situated to implementing needed changes. Future research should focus on the potential for success from these efforts in more typical provider settings.
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