Catalyst for Payment Reform

Using Policy Levers to Drive Change: A Last Resort?

Using Policy Levers to Drive Change: A Last Resort?

Let’s face it. Something has got to give. While employers and health care purchasers have long tried to implement market-based solutions, catalyzing consistent and long lasting system-wide change in health care has proven to be difficult. Although some purchasers have seen cost savings and quality improvements as a result of payment and delivery reform initiatives, quality improvement efforts, and digital health solutions, the health care industry and consumers continue to see soaring costs, unchecked market power, and substantial profit margins year after year. Despite many stakeholders’ best efforts to spur change, there may be some areas of our fragmented health care system that will require federal and state policy solutions to drive lasting value for consumers and revitalize market dynamics.

Take the backbone of payment in the American health care system, for example. The Medicare Physician Fee Schedule has been in place for over twenty years and acts as the cornerstone for payments and contracted rates for other payers, including commercial insurance markets. Since its inception, the fee schedule has prioritized and rewarded physicians for the volume of services they provide rather than the value of the care they deliver- incentivizing overtreatment rather than preventive care.

While health care purchasers and health plans, like Anthem, have tried to improve care quality by adjusting the fee schedule, the fee schedule continues to be the foundation of health care payments from a regulatory perspective.  Thus, policy interventions to “revamp the fee schedule” to more accurately align with the current health care market’s conditions and better meet the goals of value-oriented payment must be taken seriously.

With our ear to the concerns of health care purchasers, we’ve curated a free webinar series around this and other muddied issues in health care that may benefit from policy interventions. This four part webinar series will feature expert policy leaders and health care innovators who are committed to catalyzing industry change and revitalizing the marketplace in areas like market power oversight, rising health care prices, and last but not least, pharmacy pricing.


Leave a Reply

Contact Us


View Blog Archives