The Center for Healthcare Quality and Payment Reform was established in 2008 to encourage comprehensive, outcome-driven, regionally-grounded approaches to achieving higher-value
healthcare. The Jewish Healthcare Foundation provided funding to help support the Center's initial operations in 2009 and early 2010. The Center's strategic approach is unique in the following ways:
- Fundamental Payment Reform Instead of P4P. A huge national infrastructure has been developed over the past several years to administer modest
pay-for-performance (P4P) incentive systems on top of the existing payment structure. Although well-intentioned, this has added new administrative costs without eliminating
any existing costs or eliminating the counterproductive incentives in fee-for-service payment, and has the potential for stifling outcome-driven quality improvement by
rigidifying currently accepted processes. The Center for Healthcare Quality and Payment Reform focuses on truly fundamental payment reforms, such as episode-of-care payment
and condition-specific capitation, that focus on improvements in outcomes, rather than merely process measures.
- Payment Reform as a Means to Better Value, Rather Than an End in Itself. Too often, payment reforms of all types are discussed as ends in themselves,
rather as means to enable and encourage specific changes in care delivery. For example, P4P systems are designed to provide additional payments as incentives for healthcare
providers to deliver better quality-care, when the problem in many cases is not a lack of willingness by the providers, but a lack of ability to redirect current payments in
ways that will result in better-quality care. Even where care changes and payment changes are discussed jointly, as in efforts to implement the patient-centered medical home,
proposals tend to add new layers of payment, while leaving existing incentives in place, and to focus on processes, rather than outcomes. The Center for Healthcare Quality and
Payment Reform focuses on defining comprehensive, outcome-driven solutions including not only payment changes but also the care delivery changes they will support.
- Bottom-Up Rather than Top-Down Reform. Healthcare is delivered at the local level and is paid for primarily at the local or regional level. Regions of
the country differ dramatically in the structure of provider organizations and payment systems, so it is unlikely that there will be any one-size-fits-all structure that will
work effectively, at least in the short run. The Center for Healthcare Quality and Payment Reform focuses on how to design payment and care delivery reforms based on the
unique assets and barriers which exist in individual regions, and with the active input and involvement of the actual providers, payers, purchasers, and patients who will need
to implement them.
- Pragmatic Pathways to Reform. Relatively few healthcare providers have the organizational structure or skills in quality improvement or process redesign
to immediately accept new payment structures. Since current healthcare payment systems primarily reward volume, not quality or efficiency, it is likely that skills in
designing and managing care processes to improve quality and control costs will be in short supply until the incentives change. Consequently, the Center for Healthcare Quality
and Payment Reform not only works to define the ultimate structures for payment reform and improved delivery, but also to design transitional improvements to both payment
systems and organizational structures that will facilitate the transition to those ultimate structures - a "co-evolution" of payment and organizational capacity.
- Win-Win-Win Solutions. Better approaches to care delivery have the potential to improve patient outcomes and reduce healthcare spending, but current payment
systems penalize healthcare providers for implementing these approaches. Alternative payment systems which not only provide better incentives for quality, but which also
avoid creating unnecessarily severe financial dislocations for providers, are more likely to receive the support necessary for implementation. The Center for Healthcare
Quality and Payment Reform not only examines aggregate financial impacts of policy changes, but seeks to find win-win-win solutions for both payers and providers as well as
- Broad-Based Understanding of the Problems and Solutions. The kinds of payment and delivery changes needed will require the understanding and support of all
stakeholders in the healthcare system, ranging from patients to physicians to public officials. The Center for Healthcare Quality and Payment Reform translates payment and
delivery system reform concepts into easily understood terms for both laymen and experts.
- A National Network for Change. Although care delivery and payment changes must be implemented at the local level, this does not mean that payment reform
should be a parochial enterprise - regional initiatives across the country should work to coordinate their efforts, and national organizations should support the development,
evaluation, and replication of regional payment demonstrations. The Center for Healthcare Quality and Payment Reform is working in partnership with the
Network for Regional Healthcare Improvement to establish a diverse, national network of both practitioners and
thought leaders who can support needed changes at both the local and national levels.