Payment Reform Is a Start

To achieve real health care reform, several fundamentals need to be addressed. As a nation, we need to continue to improve access to health care. As individuals, we need to change our behavior as consumers of health care, and adopt healthier life styles. And as health care organizations, we need to dramatically change how care is delivered. However, in order to achieve any real reform in care delivery, many believe we need to radically change how care is paid for.

Our current payment system is characterized as rewarding volume, not value. Most believe that genuine health care reform depends on to moving to a system that rewards value.

Federal legislation passed earlier this year includes some positive steps in the direction of payment reform. The idea of Accountable Care Organizations is to reward providers for achieving targeted improvements in care quality and cost. Other payment reform experiments are underway in markets across the country. But these are modest steps at best, and are often viewed with great anxiety and suspicion on the part of health care organizations. Some see payment reform as a return to the failed capitation approaches of the 1980s and early 1990s. Others see new models of payment such as "Episodes of Care" and "Global Payments" as productive ways to provide both incentives and rewards for delivering better care at lower costs.

These issues deserve thorough discussion and debate in both formal and casual forums—like this blog. What do you think?

• Is payment reform the key to achieving health care reform?
• Who should lead payment reform initiatives? Providers? Payors? Government?
• If you could design the perfect payment model, what would it look like?

Let the debate begin.