The Catalyst for Payment Reform (CPR), an independent, non-profit group working on behalf of large healthcare purchasers, Tuesday released its first annual National Scorecard on Payment Reform, which showed that 89.1% of these payments are still based on the traditional fee-for-service model and not tied to improving quality outcomes or reducing waste.
The balance, 10.9% of payments made by commercial health plans to providers, are value-oriented, CPR determined.
Funded by the Commonwealth Fund and the California HealthCare Foundation, the scorecard is based on data voluntarily submitted by health plans on a self-reported basis to eValue8, the National Business Coalition on Health's annual Request for Information to health plans. The data represents nearly half of individuals covered by commercial health plans.
During a live webinar announcing the scorecard results, Suzanne Delbanco, CPR executive director, said the organization has set a goal to have 20% of commercial health plan payments be value-oriented by 2020.
"We help organize all of these purchasers to ask for the same changes at the same time so we can really move the dial. We try to highlight the urgency of payment reform and highlight the urgency of action, and the scorecard is part of what is helping us do that today," Delbanco says.
While the 10.9% reflects progress from 2010 when only 1% to 3% of payments were value-oriented, Delbanco says there remains a great deal of room for improvement. "As you can see, we've made a fair amount of progress … We commend all the stakeholders in healthcare who have made that progress, but you can see this is also a call to action… There is no doubt in my mind that these results will keep the conversation going."
Other key scorecard findings include:
- Of the 11% of value-oriented payments, 43% offer providers financial incentives through potential bonuses or added payment to support higher-quality care; 57% put providers at financial risk for their performance if certain quality and costs goals are not met.
- 6% of payments made to specialist are value-oriented.
- 6% of payments made to primary care physicians are value-oriented.
- Of total outpatient payments, 75% are made to specialists; 25% are made to primary care physicians.
- 2% of commercial health plan members are attributed to a provider participating in a new model of care, such as an accountable care organization or patient-centered medical home.
- 9% of hospital admissions are readmissions within 30 days of a discharge.
In an interview after the webinar, Delbanco stressed the importance of creating new payment methods in order to improve the cost and quality of care.
"We know that if we don't create the right set of incentives for healthcare quality improvements and cost containment through our payment system, then we will get exactly what we are paying for today. We need to implement payment methods that pay for quality improvement and support quality and create incentives to reduce waste," she says.
See Also: Less Than 1% of Health Plan Premiums Spent on Quality
Successfully reining in costs while advancing outcomes will require participation from all segments of the healthcare industry, Delbanco says.
"When you look at the national scorecard findings, they aren't a judgment on any one sector of the healthcare system. No one stakeholder can change payments on its own. While CPR is made up largely of healthcare purchasers, they are dependent on the health plans, and, of course, it is up to doctors and hospitals to be willing to accept new forms of payment."
Delbanco is optimistic that CPR will reach its goal and believes the organization will likely set an even more aggressive benchmark for the future. "We have a good chance of beating our goal of 20% by 2020… The important thing is that the 20% was never meant to be a cap… It was meant to set a near-term goal that we could track our progress against that was somewhere between ambitious and realistic. We'll be looking to put our eye on a more ambitious target over time, I'm sure."
Along with the scorecard, CPR also unveiled the National Compendium on Payment Reform, an online database intended to catalogue the various payment reform programs underway across the country. Providers and plans can add their payment reform programs to the Compendium, which CPR says will grow over time.