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Adopting multipayer value-based payment models
Adopting multipayer value-based payment models
- Collection:
- Health Policy and Services Research
- Series Title(s):
- State strategies for controlling health care costs implementation guide
- Author(s):
- Bailitl Michael, author
Flaherty, Grace, author
Hwang, Ann, author - Contributor(s):
- Commonwealth Fund, issuing body.
- Publication:
- [New York, New York] : The Commonwealth Fund, January 2023
- Language(s):
- English
- Format:
- Text
- Subject(s):
- Cost Control
Health Care Costs
Reimbursement Mechanisms
Value-Based Purchasing
State Government
United States - Genre(s):
- Technical Report
- Abstract:
- Value-based payment (VBP) is a health care purchasing strategy used to hold health care providers accountable for the quality and cost of care they deliver to patients. In contrast to fee-for-service models, which incentivize provision of a higher volume of services, VBP models can promote higher-quality, more equitable, more cost-effective, and better-coordinated care. Moreover, these models can potentially slow the rate of health care cost growth by applying a budgeting mechanism to payment. VBP models are most effective and sustainable when multiple payers align around a common VBP model, such as one featuring similar quality measures and payment structure. As discussed later in this guide, such multipayer VBP models can involve different degrees of alignment, from nearly full to quite loose. States have tested a variety of multipayer VBP models, including hospital global budgeting, episode-based payment, and total-cost-of-care contracting. This guide lays out concrete steps for states to plan and implement multipayer VBP models to slow spending growth in the commercial market and potentially improve the overall quality of care. The following steps present a sequence of important decisions for states to work through. States should be prepared for a process that is both iterative, where questions may need to be revisited over time, and dynamic, to account for new questions and new answers that may emerge. Step 1. Determine goals for adopting a multipayer VBP model and confirm readiness to proceed. Step 2. Select payment model(s). Step 3. Determine who should convene, facilitate, and manage the multipayer VBP arrangement(s). Step 4. Determine how to engage stakeholders during the VBP model design process. Step 5. Reach consensus on VBP model goals with stakeholders. Step 6. Design the VBP model. Step 7. Incorporate health equity into the model design, implementation, and evaluation. Step 8. Determine whether to make participation voluntary or mandatory. Step 9. Determine how aligned the multipayer model will be. Step 10. Identify opportunities for alignment with federal efforts. Step 11. Decide how the state will support providers to succeed in their VBP model. Step 12. Create a supportive health information infrastructure. Step 13. Create a plan for how the state will monitor progress toward its goals and use those results to inform any design modifications. Step 14. Anticipate negative consequences in the model design and create a plan for monitoring and correcting them during model implementation.
- Copyright:
- Reproduced with permission of the copyright holder. Further use of the material is subject to CC BY license. (More information)
- Extent:
- 1 online resource (1 PDF file (17 pages, 1 unnumbered page)).
- NLM Unique ID:
- 9918540687506676 (See catalog record)
- Permanent Link:
- http://resource.nlm.nih.gov/9918540687506676