Despite all the talk about paying for value in health care, only about 1 percent of private-sector payments to physicians and hospitals last year reflected the providers' performance.
So says Catalyst for Payment Reform, an independent group representing Walmart, Intel Corp., GE and several more of the nation's biggest health care purchasers. CPR Executive Director Suzanne Delbanco says the breadth and depth of value-oriented health care payments today is superficial, affecting few providers, few payers and just that tiny fraction of total health care expenditures.
CPR wants 20 percent of aggregate net payments to providers to be value-oriented by 2020, and it is using its considerable muscle to make that happen.
"We have to increase by 2.5 percent each year until 2020, which doesn't sound so crazy," Delbanco says. "I think it's realistic."
The key is identifying which payment strategies are most effective and implementing them broadly while putting the pressure on health plans to stop paying hospitals and physicians on the volume of services they deliver.
To that end, CPR next March will issue its first annual National Scorecard on Payment Reform to measure the nation's progress on the pay-for-value path. It also will release a National Compendium on Payment Reform, a free, Web-based, searchable database of private-sector payment reform initiatives.
The information will be collected from the health plans that report their performance to health care purchasers using the eValue8 platform developed by the National Business Coalition on Health, which includes 56 health-purchasing coalitions representing more than 7,000 employees. NBCH President and CEO Andrew Webber says all major national insurers and many regional plans report their performance using the eValue8 tool.
While bundled payments, shared savings programs and other pay-for-performance concepts get the most attention in pay-for-value discussions, CPR acknowledges that fee-for-service will not disappear overnight. Even as she pushes for its demise, Delbanco says fee-for-service innovations also can qualify as value-oriented breakthroughs.
One example is Aetna's decision to pay the same rate for cesarean and vaginal births, thereby eliminating the financial incentive to perform C-sections. Another: Safeway's policy of paying $1,250 for screening colonoscopies, regardless of where they are performed, instead of paying $900 to one provider and $7,200 to another, as it had in the past.
Webber shares CPR's sense of urgency, saying payment reform is foundational to the health care delivery system reform needed to solve the cost crisis. "One cannot happen without the other," he says. "We can use the national scorecard as a call to action and an accountability tool for measuring progress and real advancements on payment reform."