Posing A Framework To Guide Government's Role In Payment And Delivery System Reform.
Health Affairs (Impact Factor: 4.97). 09/2012; 31(9):2043-50. DOI: 10.1377/hlthaff.2012.0382
Innovative payment reform initiatives occur in both the public and private sector, but the optimal role in such reforms of the public sector, specifically the Centers for Medicare and Medicaid Services, is up for debate. In this article we examine recent experiences with public-private collaboration on payment and delivery reform and present a framework for determining the role of the government in spurring reform. We argue that as a purchaser, the government should consider the scale and maturity of private-sector activity in determining how to approach designing and implementing payment and delivery system reform. The government can further spur innovation by implementing payment reform for providers less ready to participate in it-such as smaller provider groups with limited organizational and technological capacity to implement reform-through identifying best practices related to attribution models and quality benchmarks and promoting dialogue with the private sector about the testing of new reform programs.
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ABSTRACT: In recent years there has been a significant expansion in the use of provider performance measures for quality improvement, payment, and public reporting. Using data from a survey of health plans, we characterize the use of such performance measures by private payers. We also compare the use of these measures among selected private and public programs. We studied twenty-three health plans with 121 million commercial enrollees-66 percent of the national commercial enrollment. The health plans reported using 546 distinct performance measures. There was much variation in the use of performance measures in both private and public payment and care delivery programs, despite common areas of focus that included cardiovascular conditions, diabetes, and preventive services. We conclude that policy makers and stakeholders who seek less variability in the use of performance measures to increase consistency should balance this goal with the need for flexibility to meet the needs of specific populations and promote innovation.Health Affairs 08/2013; 32(8):1453-61. DOI:10.1377/hlthaff.2013.0007 · 4.97 Impact Factor
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