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Published on: February 16, 2011
Paying for quality and coordination: aligning provider payments with global goals
Norbert I Goldfield1, Richard L Fuller, Richard F Averill
13M Health Information Systems, Wallingford, Connecticut 06492, USA.
Summary
Policy reform aims to improve healthcare quality and efficiency via provider coordination. This involves defining accountability and measuring value, using payment design for transparent, coordinated care encounters.
Area of Science:
- Health Services Research
- Healthcare Policy
- Health Economics
Background:
- Healthcare policy reform increasingly emphasizes improving care quality and efficiency.
- Provider coordination is a key strategy for achieving these goals.
- Addressing stakeholder accountability and measuring value are critical challenges.
Purpose of the Study:
- To propose a framework for incentivizing provider coordination in healthcare.
- To outline methods for apportioning stakeholder accountability.
- To define approaches for measuring increased value in healthcare delivery.
Main Methods:
- Defining four basic types of healthcare encounters.
- Utilizing payment design to specify accountability for these encounters.
- Employing a building block approach for payment systems.
Main Results:
- Incentives for coordination can be created by specifying accountability for defined healthcare encounters.
- Payment design can identify narrow units of service for transparency, with aggregation capabilities.
- Transparency can be achieved through categorical or rules-based models like Diagnosis Related Groups (DRGs).
Conclusions:
- A structured payment system, based on defined encounters and transparency, can encourage improved coordination of health services.
- This approach supports policy goals of enhancing care quality and efficiency.
- Apportioning accountability and measuring value are integral to successful healthcare reform.
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