The Roadmap to Value-Driven Health Care

Blog posted by Nancy Rehkamp

Value-driven health care has a number of definitions, but when used by CMS it describes the alignment of payment more directly with quality and efficiency of care. CMS has created a three-to-five year roadmap to achieving value-driven health care and summarized it in the report: Roadmap for Implementing Value Driven Healthcare in the Traditional Medicare Fee for Service Program. The report is not dated, but from much of the references and information it appears the report was written and released in 2008, meaning we are in year two of this current roadmap. If CMS sticks with its timeline we may be charting a course to implement payment reform sooner rather than later.

 

With the Deficit Reduction Act of 2005 (DRA), CMS began transitioning from a passive purchaser to an active purchaser of high-quality affordable care. Value-Based Purchasing (VBP) as outlined by CMS focuses on achieving the vision: Patient centered high quality health care delivered efficiently. This report highlights the work completed and the demonstrations being conducted to create incentives resulting in clinical and financial accountability and alignment across providers.

 

The key elements of VBP include:

1. Identification and use of quality measures through pay-for-reporting
2. Payment for quality
3. Resource utilization by provider
4. Performance incentives that promote efficiency while providing high-quality care
5. Aligning incentives among providers
6. Transparency and public reporting

The roadmap summarizes the purpose, issues being evaluated, and the results of each payment reform demonstration being sponsored by Medicare by key element categories. The report also summarizes demonstrations being planned and other issues that are critical to VBP which are not yet resolved including the key infrastructure tools health care providers need to be successful. Reading through this report I am struck by the depth of analysis that has already been completed on payment reform models.

 

In the upcoming weeks we will walk you through the proposed VBP for physicians and other professionals. One of the key summary documents from CMS lists 18 different payment models by the scope of the payment model, measures used, patients included, the data collected, how that data is used for payments, the type of incentives provided, the calculation of the payment incentives, and the status of the payment model. This listing includes all payment reform models identified by CMS, including those being tested by other payers.

 

We hope you will take the time to scan the report to understand the progression of the work being done on payment reform.