Which models work best
As far as which models are most successful, Caballero says that’s more difficult to discern. “While we have a solid idea of where the nation is in its adoption of payment reform models, we do not have great insight into the models that are most successful,” she says. “It has been challenging to learn what payment reforms are working because there is a lack of independent, consistent, evaluation on the programs. We hope to build the demand for evaluations of payment reform programs so we can learn what works, what doesn’t, and why.”
Overall, she says most models still rely on a fee schedule where providers are paid a certain amount for every test, procedure, or service. These models, however, also incorporate quality measures that assess the providers’ performance in a variety of areas, and performance on those measures is then translated into some type of bonus or incentive payment.
New grant funding will allow CPR to begin tracking the impact of payment report in its research. “Our goal is to examine how the increasing prevalence of payment reform correlates with cost and quality outcomes,” Caballero says. The pilot study will investigate data from three states initially, with results expected in summer or fall of 2018.
In terms of value-based payment’s impact on quality of care, The Physicians Foundation report revealed concerns about the patient satisfaction element of value-based scoring.
“Many physicians who added written comments to the survey express the belief that patient satisfaction is not a valid method for assessing physician competence, and that such a rating method encourages doctors to tell patients what they want to hear rather than what they need to hear,” the report notes.
When it comes to cost, while results are preliminary in most areas, it seems that a focus on value-based payments are at the very least encouraging the industry to take a closer look at reimagining its processes.
Cheryl L. Damberg, PhD, MPH, principal policy researcher at the RAND Corporation, RAND distinguished chair in healthcare payment policy, and professor at the Pardee RAND Graduate School says there has been major progress on bundled payments. There is now monitoring of both hospital and physician performance in this scope, so that the result isn’t just lower cost, but also better care coordination.
“I think bundled payments potentially can work and try to improve the coordination between different providers,” Damberg says, noting there has traditionally been some operational challenges when it comes to implementing bundled payment programs. “I think that there’s great opportunity in the area of bundled payments once people work through some of these operational issues, and there is a lot of promise for improved coordination.”