fah hospital policy blog

Perspectives on health policy affecting America’s hospitals and the patients we serve.

Looking to the Future of Value Based Payments

April 18, 2017 | Chip Kahn

Category: Health Care Delivery, Quality, Transparency

Measures that matter, return on investment, and meaningful reporting – these are three things our industry needs to focus on as we look to the future of value based payments.

Today, I joined experts from all sectors of the health care continuum as we discussed “Securing the Future of Value Based Payment” before a crowd of almost 300 at a Health Affairs Forum. In thinking through the future of value based payment, there are two key questions that need to be considered:

First - are we focusing on measures that matter? And second, if we can get the measurement right, can we adopt a platform that deploys those measures across health care settings to inform patient care and improve accountability, while at the same time reducing the current redundancies and inefficiencies?

From my viewpoint, the answer to the first question is not enough.

We do have a few measures that matter. They include the reduction of elective deliveries before 39 weeks and readmissions measures, the latter of which are flawed, but have brought attention to an area where we have achieved great improvement.

The answer to the second question is that our industry still lacks a process that ensures consistent measurement across patient care settings and value based payment programs.

Instead, we have a Balkanized quality measurement and reporting process. Clinicians and providers are currently required to collect similar data elements for reporting on different measures and measure specifications for different value based payment programs and systems in both the public and private sectors. This variation is arbitrary and diverts attention and resources from what is most important – improving patient care by using effective performance data.. 

I believe if we truly focus on measures that matter we can bring a return on investment for patients, caregivers, payors and purchasers.

Of course, return on investment (ROI) is a classic business term, not something usually associated with health care. Rather than thinking of it as a purely financial metric about money earned relative to the costs of an investment, I think its meaning can be stretched to the performance measurement space.

In this context, the investment is the time and resources and resulting improvement efforts.  In other words,– currency and human capital – that those in health care contribute to collecting, reporting, and analyzing the data, as well as the result of improved patient care. 

The return should meet the three measurement purposes that have the most meaningful impacts on all stakeholders – improved care, accountability, and transparent/useable information.

Focusing on ROI also reframes the current measurement discourse around reducing burden.  Burden is an important consideration that we should strive to reduce – and eliminate when there is no ROI – but it is one part of the equation, not the sole focus.

If we can agree on the purposes of measurement and the desire to improve ROI across the system, then what is the best platform to align the needs of various stakeholders in developing, disseminating, and utilizing these measures?

My experience with the National Quality Forum’s (NQF) Measure Applications Partnership (“the MAP”) tells me that it is possible to develop a platform to serve that role. The MAP already includes the key elements for success, including multi-stakeholder involvement and a public/private partnership. To fill the role I’ve laid out here, it would need to expand from federal programs, such as Medicare and Medicaid, to include those in other public and private spheres as well.

This would of course require buy-in from a wide array of stakeholders, including industry-led groups. To achieve success, we would also need broader participation, more formalized rules of the road, and increased transparency.

For this to work, we must also address the variation within the health care system. We need uniform measures to the extent possible, but they must balance the differences among providers with the ability to compare across settings and systems.

Meaningful reporting – aligning the use of measures across payors – is one way to move us toward measures that matter and free up energy and resources that caregivers can use to innovate patient-centered care delivery.

So if we agree on the goals of measurement, the need for tangible ROI, and the process for moving forward, this could create a solid platform for the next step – reassessing current federal payment programs to ensure they align with the overall goals and work that already is being done in many states. 

This forum was a great venue to continue the discussion. It is clear that it is now time to pave the way for more refined, focused, and purposeful value-based programs.