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Payment Reform Evaluation: Lessons from State and Regional Efforts

Overview

Health care leaders, policymakers, and researchers agree that health services delivery in the United States is in need of major change. Most experts believe many problems with the health care system can be attributed to compensation models which misalign financial incentives lead to undesirable outcomes. Recognizing these issues, various organizations seek to realign financial incentives with the goals of improving quality and enhancing value.

This project will perform cross-cutting evaluation of eight payment reform efforts designed to promote high-value health care outcomes through leveraging existing market knowledge, partnerships and resources in different states and regions of the United States.

Aims

The primary aim of the evaluation is to draw general lessons by comparing and contrasting implementation processes and intermediate outcomes of the state and regional projects.

The evaluation will:

  • Examine implementation of payment reform projects with differing market environments, resources, implementation strategies, and stakeholders;
  • Identify barriers and facilitators to successful value-based payment reforms in differing contexts -- distilling general lessons for national healthcare policy and practice;
  • Combine original qualitative key informant data with existing qualitative and quantitative data to compare and contrast probable effects of specific payment reform projects on utilization, cost, and quality of health services, as well as patient experience and provider satisfaction.

The evaluation is oriented to policymakers (at local, state, and federal levels) and leaders in the private sector: employers, labor, health plans, healthcare providers, and consumer groups.

Purpose

The purpose of the evaluation is to illuminate general understanding and provide insights regarding health care payment reform by:

  • Examining experience of 8 project sites
  • Discerning cross-cutting lessons among sites
  • Contrasting payment reform approaches, results, and community, organizational, and market factors across sites
  • Identifying barriers & facilitators to state and regional payment reform

Funding

The State and Regional Payment Reform Evaluation project is funded by the Robert Wood Johnson Foundation (Grant #68839). Please visit RWJF's website at www.rwjf.org.