Viewpoint: Don't give up on payment reform yet

The results are in and many value-based care attempts appear to fall short of their goals, but this does not mean the healthcare industry should be discouraged just yet, according to a recent blog from Health Affairs.

For example, "the ACA's flagship payment initiative," the Medicare Shared Savings Program, cost Medicare $216 million by the end of 2015, according to the report. Bundled payments for spinal surgery increased costs by more than 10 percent, and while bundles for orthopedics and cardiology were able to achieve 3 percent savings, it all came from the post-acute setting. Even patient-centered medical homes were unable to reduce cost or improve quality on average.

"The point is not that any of these activities is wasteful, but evidence suggests that they were not well targeted to a smaller group of individuals who would benefit most from the additional resources," the authors wrote.

They identified the following learnings from existing value-based care initiatives to bring to the next the iteration of payment reform.

  1. Improving cost and quality takes time.
  2. Targeting initiatives to specific patient groups should take precedence over spreading initiatives to all patients.
  3. Savings come from unexpected areas of the care continuum.
  4. Transformation comes only after committing resources, sharing data and realigning incentives.
  5. Payment reform will require more aggressive cost reduction than those that do not require providers to take on downside risk.

Read the full blog here.


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