Health care spending in America has been on the rise for quite some time, and it’s projected to continue to increase for at least the next decade. Experts attribute this persistent growth in spending to many factors, and most agree that the current trend is unsustainable. In response, many stakeholders – including health plans, employers and the government – are homing in on payment reform as a way not only to rein in health care spending but to reward high-quality care and achieve better outcomes for patients.
Indeed, many efforts are underway to shift the health care system from the current fee-for-service model – in which all services, regardless of their impact on patient health, are paid for – to payment models that reimburse for care based on outcomes, such as:
- bundled payments for multiple, related services, such as all the services required to treat a heart attack;
- value-based purchasing that rewards performance against established measures;
- reference pricing that sets standard prices for common procedures that do not vary much in quality, such as MRIs;
- accountable care organizations (ACOs) that share responsibility for coordinating care; and
- patient-centered medical homes (PCMHs) that coordinate a patient’s primary and specialty care.