Payment Reform

The report is designed to help leaders - including providers, payers, and employers - who are working, or wish to work, in alternative payment models (APMs) to understand what information they will need from outside their organization and the processes involved in obtaining that information. It is also an aid for third party entities, including vendors, policymakers and others that provide access to the data sources and data sharing processes that support APM efforts.

Many physicians, hospitals, and other providers across the country find that the current fee–for–service payment system creates barriers to implementing or sustaining better approaches to health care delivery. Consequently, payment reforms must be an integral part of any strategy to create a higher–value health care system. This white paper describes the building blocks for successful payment reform and how communities might approach these building blocks to meet their unique circumstances.

This issue brief describes why the industry must move beyond common but insufficient methods of measuring cost of care, and toward total cost of care, and what types of entities are well-positioned to lead this work. It presents five core components of measuring, analyzing, and reporting total cost, and presents the challenges associated with this task.

Over three years, Regional Health Improvement Collaboratives, working collectively through the Network for Regional Healthcare Improvement, have demonstrated the ability to assess, refine and standardize raw regional healthcare cost data and use it to establish meaningful, local practice level reports and comparisons within and between healthcare markets. This work advances healthcare cost transparency, a necessity for solving the healthcare cost crisis. This report summarizes key findings.

This white paper offers guiding principles and recommendations that should be considered in data sharing arrangements in Population-Based Payment models. The paper outlines a series of “use cases” for data sharing that describe particular types of data sharing arrangements, in both their current and aspirational states. The goal is to create an environment where data follows the patient and is available to all stakeholders (patients, providers, purchasers, and payers) in a timely manner.

This slide deck from the Health Care Payment Learning and Action Network presentation on April 26, 2016 is helpful in understanding an overview of the Population-Based Payment Work Group’s preliminary recommendations related to sharing data within a population-based payment model, and share stakeholders' perspectives for implementation of draft recommendations.