As AHA Chairman Jim Hinton said in this interview, the majority of U.S. hospitals are struggling to navigate the tricky landscape between fee for service and a more risk-based environment. Part of that challenge, I think, is that we still don't fully understand how some of the drivers of value-based care are going to pan out. Despite multiple experiments, there's still considerable uncertainty around how such concepts as bundled payments and accountable care will, in reality, propel us toward the Triple Aim.
Two reports issued earlier this week detail some of the challenges facing the field and policymakers:

  • In "Measuring Success in Health Care Value-Based Purchasing Programs," researchers at RAND Corp., assessed a 10-year evolution of new reimbursement models. The review was part of contract RAND has with HHS. "Although the past decade has witnessed a fair amount of experimentation with performance-based payment models, primarily P4P programs, we still know very little about how best to design and implement VBP programs to achieve stated goals and what constitutes a successful program," the researchers noted. The report identifies a multitude of challenges in assessing VBP programs, some of which relate to various research methodologies being used. Some of the problems center around the design of the VBP programs. Among their recommendations, the RAND researchers suggested that entities advancing VBP "engage providers in the design and implementation … and support provider efforts to improve." The report also calls on HHS to develop a more comprehensive strategy around VBP. It's an interesting read for anyone who thinks their organization is about the take one foot off of the proverbial dock and place it in the boat.
  •  A second report by consulting firm Dobson DaVanzo & Associates argues that "structural changes implemented across the health care industry" are the main reason for the significant slowing of health care costs. The report, which was released by the Federation of American Hospitals, points out that health care spending is projected to grow at 3.8 percent in 2013, the fourth consecutive year of low growth. With so many new concepts being field tested, the report urges policymakers to "support and encourage the reform efforts already in motion and allow time for further implementation and evaluation…"
  • In a third, albeit less scientific, report from Huron Consulting, a collection of hospital CEOs discusses how they are driving change in their organizations and communities. Echoing Hinton's comments, several of the executives note that even as they migrate toward risk-based models, they need to keep a very close eye on revenue coming in from the fee-for-service model. Not surprisingly, physician alignment and clinical integration also top their list of priorities.

A consistent, yet somewhat paradoxical, theme emerges from all three reports: We can't wait to transform the delivery system, but we also need more time to study, assess and potentially reshape many of the concepts that are in play. I don't envy hospital leaders who have to manage in this environment.

Now, if you want to talk about truly transforming care delivery, how about real-life initiatives that are shaping care at the bedside? The Cambia Health Foundation is accepting applications for the Sojourns Scholar Leadership Program, which is aimed at promoting and training the next generation of palliative care leaders. Up to six applicants will be picked for a two-year, $180,000 grant.

"This is a critically important effort," said Dr. Steven Pantilat, director of UCSF Palliative Care Program, who chairs the Sojourns Scholar Advisory Committee. "We want to promote and encourage the next generation of leaders in palliative care and shine a light on people who are making a difference in improving care for people with serious illness. We hope this initiative will bring national visibility to their efforts and innovations."

Applications are due by March 10. Comment: Twitter