Posing a framework to guide government's role in payment and delivery system reform

Area of Science:

• Health economics
• Healthcare policy
• Public health administration

Background:

• Payment reform initiatives are emerging in both public and private sectors.
• The specific role of the Centers for Medicare and Medicaid Services (CMS) in these reforms is debated.
• Effective public-private collaboration is crucial for successful healthcare payment and delivery reform.

Purpose of the Study:

• To examine recent experiences with public-private collaboration on payment and delivery reform.
• To present a framework for defining the government's role in driving reform.
• To provide guidance for the Centers for Medicare and Medicaid Services (CMS) in designing and implementing reforms.

Main Methods:

• Analysis of recent public-private collaboration experiences in payment and delivery reform.
• Development of a framework to guide government involvement.
• Examination of strategies to support providers with limited capacity for reform.

Main Results:

• Government's role should adapt to the scale and maturity of private-sector activity.
• CMS can stimulate innovation by implementing reforms for less-prepared providers.
• Identifying best practices for attribution models and quality benchmarks is key.

Conclusions:

• The government, as a purchaser, must strategically align its reform efforts with private sector capabilities.
• Targeted support and dialogue are essential to foster innovation among smaller or less-resourced providers.
• A nuanced approach by CMS can accelerate the adoption of effective payment and delivery system reforms.