As health care costs continue to rise and the quality of care remains inconsistent, employers, other private and public health care purchasers, health plans, and providers are now experimenting in earnest with reforms to how we deliver and pay for health care. Investment in such efforts will be well worth it if they significantly improve care and make it more affordable.
However, despite the flurry of activity in the payment reform space over the last few years, data demonstrating the effectiveness of these reforms are limited. We still have much to learn about which reforms will work and in what context they will successfully produce their intended outcomes.
Thus, there is a pressing need to amass more evidence about the impact of various approaches and to compare outcomes across programs. However, most health care delivery and payment reforms are accompanied by evaluations that are not standardized — they are often evaluated in-house and lack rigor. This makes apples-to-apples comparisons across programs difficult. Additionally, these evaluations may be designed to highlight the strengths of the program, while masking its weaknesses.
What if the health care industry were to agree to some general parameters for evaluation that are meaningful to those who use and pay for care? By definition, this would mean greater rigor and consistency in the evaluation process. Ideally, it would highlight all aspects of a payment reform program (positive and negative) and send a clear signal to those sponsoring reform efforts about what outcomes are most meaningful to purchasers, consumers, and other stakeholders.
Although there is still a lot to learn about the trajectory of payment reforms in the market, and therefore how to evaluate them, it is not too early to develop a standard approach that could regularly be used by purchasers and health plans to evaluate existing programs, or to design the evaluation plans for new programs. Of course there is no “one size fits all” approach to evaluate payment reform programs, but the results of a standard evaluation process could support mid-course corrections and cross learning, and identify successful approaches that we should replicate and disseminate.
My organization, Catalyst for Payment Reform (CPR), sought the input of leading payment reform experts to help determine what a standard approach to evaluation might entail. In addition, we gathered feedback on the feasibility of our thinking from large health insurers who could be asked to cooperate with this approach. Our membership, which includes a mix of large private employers and state Medicaid, employee, and retiree agencies, also helped us prioritize and focus.
To be clear, we did not focus on research methodology; we did not determine whether it is always best to have a comparison group or to use particular benchmarks, or whether an evaluation is only credible if it contains a randomized experiment versus a difference-in-difference analysis. Instead, we concentrated on the domains we believe are most critical to address in any evaluation, including program design, feasibility, cost and quality, and the specific elements within those domains employers and other health care purchasers most want to know about.
Four Core Domains For Evaluation
Program Design
Employers and other health care purchasers want to have their eyes wide open when they consider reform programs for their covered populations. Even though it won’t shed light on the program’s outcomes, it is important to understand how a program is designed, its goals, the lines of business in which it is offered, its availability by region and market, which purchasers are eligible to participate, and for which insurance products it is available.
It is also critical to understand the provider payment methods at play, how quality targets are set, and what complementary benefit designs could enhance the success of the program. All of these topics can provide context for program results, as well as give the prospective or participating purchaser a sense of what to expect.
Feasibility
Furthermore, if health care purchasers want to engage in a payment reform program, they need to assess how feasible it will be to participate. For example, will the program be viable from a financial standpoint in terms of additional administrative costs or investments that they may be required to make? What about for health care providers? In addition, can the program be replicated and scaled? Programs that succeed in a singular situation but are difficult to implement will have limited impact over time. On a related note, would the provider and payer participants in the program choose to continue the next time the contract comes up for renewal?
Cost
A major goal of payment reform is to reduce the costs of health care. At the end of the day, employers and other health care purchasers want to understand the mechanisms through which the program intends to reduce costs, its impact on total health care spending, and how any savings may be passed on to them. Additionally, depending on the provider payment method in use, there may also be specific questions purchasers want to ask about the flow of money and the incentives for health care providers to improve care and reduce the use of resources.
Quality
Employers and other purchasers know that the impact of a payment reform program on the quality of care is as important as its impact on cost. Quality assessment needs to focus on priority areas — where employers are spending the most, and where there is also great variation in the quality of care and payments to providers for the same services. In addition, purchasers are eager to understand how provider payment reform programs impact patient satisfaction and patient experience of care.
We hope these ideas advance the consistency and rigor with which the health care industry evaluates its efforts. Please share your thoughts on how we can improve them.
from Health Affairs Blog http://ift.tt/1NTTc0S
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