Payment reform has taken hold. Now what?

March 27, 2018

Twenty-nine percent of payments to doctors and hospitals are through “alternative payment models” (APMs), according to the Health Care Payment Learning and Action Network (LAN). This includes payment reforms that go beyond pay-for-performance, and hold providers accountable for their patients’ care through quality performance and financial targets. When pay-for-performance incentives are included, the study shows that about 57 percent of payments made to doctors and hospitals are tied in some way to quality performance.

In 2010, Catalyst for Payment Reform (CPR) set a goal for payment reform, and began to track progress through our National Scorecards on Payment Reform. CPR has the goal that by 2020, 20 percent of payments to doctors and hospitals will flow through methods¬†proven to improve the value of health care,¬†tying our goals to evidence that these reforms are working. Since CPR’s National Scorecards in 2013 and 2014, and through the LAN’s measurement effort in 2016 and 2017, it is apparent that payment reform implementation is increasing at a rapid rate. But, wth now more than 50 percent of payments tied to quality in some form or another, do we know whether these reforms are leading to better, more affordable care?

We don’t know yet! When CPR set its goals, we believed that along with the proliferation of payment reform would come rigorous evaluations of the impact of these programs. However, there is little evidence out there today around which reforms are having the biggest impact. And, we’ve seen that if an evaluation is conducted, it’s usually done by the entity that implemented the program–not an independent, external reviewer–and often displays only positive results.

We will continue to track the implementation of payment reform through the LAN and in state efforts led by CPR, but tracking progress isn’t the end. It is really just the beginning. Stakeholders should also invest in rigorous, independent evaluations of payment reform programs so we can begin to understand whether they are worth the investment and improve the value of health care.

Join CPR and our campaign to evaluate the impact of payment reform in 2018!

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