Since its inception in 2005, the University of Michigan Center for Value-Based Insurance Design has led efforts to promote the development, implementation, and evaluation of innovative health benefit designs balancing cost and quality.
Payment Reform
The Commonwealth Fund: Using Insurance Standards and Policy Levers to Build a High Performance Health System
This 2009 issue brief published by The Commonwealth Fund examines an unprecedented use of state health insurance regulatory authority to promote health system reform. In 2004, the Rhode Island legislature created the Office of the Health Insurance Commissioner (OHIC) with authority not granted to state health insurance regulatory agencies in other states. Specifically, the legislation instructed OHIC to direct insurers toward policies that promote improved accessibility, quality, and affordability for the Rhode Island health system. In 2009, OHIC used this authority to implement a set of standards to promote increased affordability through a series of requirements aimed at strengthening and expanding the state’s primary care infrastructure. Insurers are required to increase their investments in primary care on a cost-neutral basis, expand use of the chronic care model medical home, and support implementation of electronic medical records. Rhode Island is testing whether state insurance regulation can foster a profound transformation in health care delivery.
Commentary: Thinking Clearly About Payment Reform
In this commentary found in The American Journal of Managed Care, Dr. Robert S. Galvin, MD, uses the current thinking about medical homes and accountable care organizations (ACOs) to argue for the importance of having a strategy for payment reform. He then suggests 4 steps that, if followed, could maximize innovation and decrease confusion as our pluralistic system moves full speed ahead on this reform.
The Commonwealth Fund: Starting on the Path to a High Performance Health System: Analysis of the Payment and System Reform Provisions in the Patient Protection and Affordable Care Act of 2010
This report, originally published in December 2009 and since updated to reflect the March 2010 passage of the Patient Protection and Affordable Care Act, analyzes the provisions in the new law that will affect providers' financial incentives, the organization and delivery of health care services, investment in prevention and population health, and the capacity to achieve the best health care and health outcomes for all. Major initiatives include establishment of health insurance exchanges and new market rules, creation of an Independent Payment Advisory Board and Center for Medicare and Medicaid Innovation, and introduction of payment policies designed to reward hospitals and physicians for value rather than volume. Recent analysis shows that these provisions have the potential to reduce administrative expenses and lead to significant modernization of the health care system, lowering the rate of cost growth and returning total national savings of $590 billion or more in the coming decade.
Brookings Institute Event - Reforming Provider Payment: Moving Toward Accountability for Quality and Value
A policy forum conducted by the Brookings Institute and Dartmouth Institute for Health Policy and Clinical Practice concluded that many of the payment reforms that have been proposed or are already in use – for example, bundled payments, disease management, and pay for performance – represent meaningful steps toward greater accountability. The next step is accountability for care that leads to better outcomes and lower costs at the person level, with support for the infrastructure required to provide high-quality, coordinated care.
CHAP Pathways Model
Community Health Access Project (CHAP) works with agencies in Ohio and nationally to develop and support tools and strategies focused on connecting those at risk to care. Community Health Worker Training, Pathways, and the Connecting Those at Risk to Care publications will provide more information.
NRHI Healthcare Payment Reform Series: Better Ways to Pay for Health Care
The Network for Regional Healthcare Improvement (NRHI) is a national coalition of Regional Health Improvement Collaboratives -- regionally-based, multi-stakeholder organizations that are working to improve the quality and value of health care delivery. NRHI provides technical assistance to Regional Health Improvement Collaboratives, facilitates information sharing among them, and encourages national policies that support efforts by Regional Health Improvement Collaboratives to improve healthcare quality and value.
This paper provides a framework for understanding how current payment systems work and how better payment systems can be designed. It is intended to help purchasers, payers, providers, policy-makers, consumers and civic leaders understand why fundamental payment reforms are needed and to encourage them to support implementation of better payment systems that will help move towards a more value-driven health care system.
National Institute for Health Care Reform
Series of publications including issues briefs, research, and more on payment reform, risk pools for the uninsured, and other health reform issues backed by UAW and the auto industry provided by the National Institute for Health Care Reform.
National Governors Association
Publications provided on the National Governors Association (NGA) website pertaining to health reform implementation and more specifically for health care delivery system issues such as payment reform, prevention and wellness, care coordination, alternative medical liability laws and more.
CMS Multi-Payer Advanced Primary Care Initiative
Under this demonstration, Centers for Medicaid and Medicare Services (CMS) will participate in multi-payer reform initiatives that are currently being conducted by states to make advanced primary care practices more broadly available. The demonstration will evaluate whether advanced primary care practice will reduce unjustified utilization and expenditures, improve the safety, effectiveness, timeliness, and efficiency of health care, increase patient decision-making and increase the availability and delivery of care in underserved areas.
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