HL20: Suzanne Delbanco, PhD—Pushing for Value-Based Payments

Suzanne Delbanco, PhD, executive director of the non-profit Catalyst for Payment Reform, has set an aggressive goal: She wants 20% of the nation's healthcare payments to be based on value by 2020.

This profile was published in the December, 2013 issue of HealthLeaders magazine.

As the healthcare industry marches slowly but steadily toward a value-based reimbursement model, Suzanne Delbanco, PhD, executive director of Catalyst for Payment Reform, believes harnessing the collective buying power of large healthcare purchasers can and will accelerate the change.

"One of our most important tenets is to try to create some consistent approaches and signals so we can actually move the market," Delbanco says of CPR, a San Francisco–based independent, nonprofit group working on behalf of large employers and other healthcare consumers to increase value-based payments, lower overall care costs, and improve outcomes. CPR's members include some of the largest employers in the country, such as Walmart, AT&T, Verizon Communications, Capital One, GE, Comcast, and 25 others.

Although she says getting all of these major players focused on the same issues is "a bit like herding cats," she also says it is the key to forging tangible results with regard to how health benefits are designed and how healthcare is purchased in the United States.

"Not only are we influencing what the plans are doing, but we also hope we'll catch the notice of providers and that they'll realize that those who are using and paying for healthcare do care about how good it is and how affordable it is," Delbanco says.

Delbanco and her colleagues at CPR have set a goal to have 20% of the nation's healthcare payments be based on value by the year 2020 and are working aggressively to move away from the current fee-for-service payment model that does not reward quality or outcomes.

"We set the goal because it seemed like a good compromise between being realistic and ambitious," Delbanco says. "We have a good chance of beating our goal. … The important thing is that the 20% was never meant to be a cap… We'll be looking to put our eye on a more ambitious target over time, I'm sure."

Based on the organization's National Scorecard on Payment Reform, which was released in March 2013, 10.9% of payments made by commercial health plans to in-network providers are currently value-oriented. Although this marks significant improvement over 2010, when 1%–3% of payments were value-based, CPR still has plenty of work to do, Delbanco says.

"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," she says. "We need to implement payment methods that pay for quality improvement and support quality and create incentives to reduce waste."

To that end, CPR offers tools to help healthcare purchasers query insurance plans about their provider payment practices; monitor the proportion of total physician and hospital payment that is value-oriented; and create contracts using new language to outline expectations around value-oriented payments, price, and quality transparency.

Successfully reining in costs while advancing outcomes will require participation from all segments of the healthcare spectrum, not just purchasers, and Delbanco knows achieving an industrywide emphasis on value will not come easily.

"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," she says. "There are deeply entrenched interests in the healthcare system and overcoming those to create better value for the patient is incredibly challenging."