Working to find actionable solutions to the nation's key challenges.

Reforming America’s Health Care Delivery System: Transitioning from Volume-Based to Value-Based Care

By Marisa Salemme

Friday, June 27, 2014

Last week, the Bipartisan Policy Center (BPC) Health Project hosted a policy forum on delivery system reform, focusing on the transition from volume-based to value-based care. This was part of a series of conversations BPC will host in the coming months on improving quality and reducing costs in our health care system. In April 2013, leaders of BPC’s Health and Economic Policy Projects produced a series of recommendations in A Bipartisan Rx for Patient-Centered Care and System-Wide Cost Containment. Building on that report, the Delivery System Reform Initiative, co-chaired by former Senate Majority Leaders Tom Daschle (D-SD) and Bill Frist (R-TN), is joined by former Congressional Budget Office (CBO) Director Alice Rivlin and former Ranking Member of the House Committee on Ways and Means Congressman Jim McCrery (R-LA).

During BPC’s public event, Dr. Patrick Conway, Deputy Administrator for Innovation & Quality and Chief Medical Officer at the Centers for Medicare and Medicaid Services, shared results to-date and key lessons learned in the federal transition of volume to value, as well as his recommendations for the future of health system transformation.

BPC also welcomed Robert J. Henkel, President and CEO of Ascension Health, the nation’s largest non-profit health system, to discuss health care provider challenges and opportunities for meaningful reform. Mr. Henkel shared Ascension’s experiences serving very diverse populations on the frontlines of urban, suburban, and rural health care to contribute to the discussion on how improve our nation’s delivery system through provider engagement.

In addition to the public forum, BPC is engaging in a series of in-depth conversations with experts and health care stakeholders from across the spectrum addressing alternative payment mechanisms (APMs) and recommendations for transitioning from the fragmented health care system we have today to one that that is built on coordination and quality. Acknowledging that we are at a critical point to create opportunities to transform our health care system and create an affordable care pattern, BPC seeks to develop recommendations on engaging both the public and private sectors, on both sides of the aisle, in delivery and payment reform.

Key takeaways from the public event include:

Patient Safety & Quality

In recent years, the US health system has seen overall patient safety improve as a result of financial incentives and investments in quality improvement of providers in the field. Making the case for the transition to the coordination of care with private payers, Dr. Conway noted how the Pioneer ACO Model has outperformed Medicare fee-for-service in clinical quality and patient experience, all while experiencing only 0.3% growth. Dr. Conway noted the success that has already been achieved in improving quality at a lower cost through the alignment of provider incentives.

Standardization of Data & Measurement

In moving forward with APMs, enhancing and standardizing data for quality and resource use is an essential component for both providers and beneficiaries. Streamlining the current quality programs into one, outcomes-based comprehensive program was discussed as essential for provider engagement. Having a single, uniform national data set that is used by both the public and private sectors incentivizes providers to participate in alternative payment methods by focusing on patient-centered outcome measures they are only required to report once. Directly linking these measurements of quality and value to payment can transform the current paradigm to a system of payment and care that works. By structuring quality measures to be patient- and outcomes- focused, we will be able to provide data that is meaningful to both providers and consumers.

New Alternative Payment Mechanisms

Although it was noted throughout the discussion that tremendous work has already been accomplished in moving towards a more integrated, high quality, patient-centered system, participants emphasized that we already need to be looking to the next generation of APMs, including ACOs. As we navigate the changing environment of healthcare delivery and payment, there must be a continued focus on improving overall health and well-being while also improving the experience of beneficiaries and providers, and doing so at a lower overall cost. Harmonizing our quality measures to incorporate patient goals of care will help transform our system to one that is based on quality and value, while transparency of data will help drive informed consumer choice and provider involvement. With this in mind, it is integral to set realistic goals while actively thinking of the next generation of population- based APMs. The ability to incorporate the diversity of clinical medicine and integrate specialties more fully into delivery system reform will be a necessary building block to successfully engaging the provider community. We must ensure that future models integrate a wider range of physicians, particularly specialists and providers in rural areas, to have opportunities within these new mechanisms.

Next Steps

BPC’s Health Project is committed to developing realistic recommendations in navigating the next generation of alternative payment mechanisms and delivery system reform. Last week’s conversation continued the discussion on how policymakers and stakeholders can lead the way in empowering and encouraging providers to choose value based on quality and cost. By aligning the federal government, stakeholders, and providers in committing to meaningful payment reform, we can move forward in transforming our health care delivery system.

In the coming months, the BPC Health Project will release a series of white papers following our discussions intended to inform on the challenges and policy options for meaningful healthcare payment reform. We welcome guidance from stakeholders and policymakers as we continue our work in transitioning from volume to more value-based care.

KEYWORDS: ALICE RIVLIN, APMS, BILL FRIST, JIM MCCRERY, PATRICK CONWAY, ROBERT J. HENKEL, TOM DASCHLE