On March 17, the Health Policy Institute of Ohio (HPIO) hosted a forum on paying for value over volume. Ohio Academy of Family Physicians Executive Vice President Ann Spicer attended representing the Academy.
- Rob Houston, senior program officer at the Center for Health Care Strategies, who spoke on navigating value-based payment reform
- Susanne Delbanco, executive director of the Catalyst for Payment Reform, who addressed payment reform readiness and evaluation
- Greg Moody, director, Governor Kasich’s Office of Health Transformation, who provided updates on Ohio’s progress in value-based payment reform through the state innovation model (SIM) grant.
Mr. Houston defined value-based payment as anything but fee–for-service (FFS). He noted examples of successful value-based payment design and implementation in other states and described the most commonly referenced models as payment for care coordination, pay for performance, bundled payments, shared savings programs, and global/capitated payments.
Ms. Delbanco expressed concern that because FFS is so baked into America’s health care system, all of this payment reform is still built upon a FFS foundation. She stated that payment reform has become an arms race among insurers/payers – and the race to escalate payment reform is largely void of appropriate evaluation to see if it’s working. She indicated that experimentation should be encouraged, but with appropriate evaluation measures. She also stressed the importance of looking at the feasibility of payment reform implementation and not just the consideration of quality and cost.
One promising comment by Ms. Delbanco, based on research completed by Catalyst for Payment Reform, was that research showed a slightly favorable rebalance of payment for primary care away from subspecialist care in the last year.
Director Moody provided an update on Ohio’s implementation of its SIM grant project which concentrates on payment focused on the patient-centered medical home model and episodes of care. For additional information, reference the article titled “Update on Statewide Spread of PCMH” is this issue.
The program concluded with a stakeholder panel discussion on payment innovations across health sectors.