Payment Reform: Analysis of Models and Performance Measurement Implications.

Area of Science:

• Health Services Research
• Health Policy
• Healthcare Economics

Background:

• US healthcare payment systems are undergoing significant transformation.
• Insurers and purchasers are piloting new payment models with quality incentives.
• The Patient Protection and Affordable Care Act (ACA) is driving payment reform.

Purpose of the Study:

• To catalogue and classify healthcare payment reform programs.
• To identify performance measurement needs for various payment models.
• To inform national quality strategy development post-ACA.

Main Methods:

• Reviewed nearly 100 implemented and proposed payment reform programs.
• Classified programs into 11 distinct payment reform models.
• Synthesized findings to identify priorities and challenges.

Main Results:

• Detailed results from a technical report on payment reform.
• Identified specific performance measurement requirements for each model.
• Highlighted near-term priorities for performance measure development.

Conclusions:

• Performance measures are crucial for effective healthcare payment reform.
• Challenges exist in utilizing performance measures for payment.
• A shared framework is established for future analysis of performance measurement opportunities.