Evaluating Payment Reform
As health care costs continue to rise and the quality of care remains inconsistent, employers, other private and public health care purchasers, health plans, and providers are now experimenting in earnest with reforms to how we deliver and pay for health care. Since data demonstrating the effectiveness of these reforms are limited, there is a pressing need to amass more evidence about the impact of various approaches and to compare outcomes across programs. CPR developed a framework for evaluating payment reform programs in an effort to establish a standard evaluation process that could support mid-course corrections, cross learning, and identify successful approaches that we should replicate and disseminate.
CPR sought the input of leading payment reform experts to help determine what a standard approach to evaluation might entail. We gathered feedback on the feasibility of our thinking from large health insurers that could be asked to cooperate with this approach. Our membership, which includes a mix of large private employers, and state Medicaid, employee and retiree agencies, also helped us prioritize and focus. We concentrated on the domains we believe are most critical to address in any evaluation, including program design, feasibility, cost, and quality, and the specific elements within those domains employers and other health care purchasers most want to know about.
CPR's How-To Guide: Evaluating Payment Reform Programs orients employers, other health care purchasers and other stakeholders in health care to CPR's Payment Reform Evaluation Framework.
Payment Reform Evaluation Framework
The Payment Reform Evaluation Framework provides a standard approach to assessing payment reform programs.
Payment Reform Definitions
CPR's Payment Reform Terms provide explanations for the terminology used in CPR's various purchaser tools and reports, including the Payment Reform Evaluation Framework.
Over the past 15 years there have been major changes in the measures we have at our disposal to assess the quality of health care that patients receive. We have gone from decentralized disorganization to measures that have been “standardized” through various multi-stakeholder consensus processes, including that of the National Quality Forum. And where there was a dearth of standard quality measures, some now argue we have too many (600-plus and counting), but not the right ones.
It turns out, based on a CPR-commissioned analysis of commercial claims data by the Health Care Incentives Improvement Institute (HCI3), there are 12 clinical areas where the most spending occurs and where the greatest variation lies in quality, safety and costs. Together with Discern Health, CPR identified the best available quality measures for these priority areas, along with the best measures to assess the performance of the health care system in broader ways such as care coordination, prevention, patient experience and safety measures. The guide consists of a total of 30 measures. We selected the measures with attention to alignment with other programs to the extent that it makes sense given our focus on the commercial population. We also identified the measure gaps that remain.
The Employer-Purchaser Guide to Quality Measure Selection can help employers and other purchasers more effectively design, implement, and evaluate health care delivery and payment reform programs.
The Action Brief: The Quality Measures that Matter can help employers and other purchasers digest the Guide and gives a call to action.
On Oct. 30, 2015, CPR held a Virtual Summit about CPR's new Employer-Purchaser Guide to Quality Measure Selection. Listen to a recording of the Virtual Summit on the Quality Measures that Matter and view the presentation slides of the speakers.