Payment Reform Evaluation Project 1

(2011 - 2013)

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.

Grant Period: 2011 - 2013

Funder: Robert Wood Johnson Foundation (Grant #68839)

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

Methods

The evaluation approach is based on a conceptual framework that refines the Aligning Forces for Quality (AF4Q) Logic Model. Our approach seeks to capture payment reform interventions in addition to the four AF4Q components: consumer engagement, performance measurement and public reporting, quality improvement, and benefit design innovation.

Methods include key informant interviews, document review, qualitative analysis, and inferences from existing quantitative data assembled by the individual project sites.

Publications

A Report on Eight Early-Stage State and Regional Projects Testing Value-Based Payment Douglas Conrad, David Grembowski, Claire Gibbons, Miriam Marcus-Smith, Susan E. Hernandez, Judy Chang, Anne Renz, Bernard Lau and Erin dela Cruz

Academy Health Annual Research Meeting Policy Roundtable, June 2013: Value-Based Provider Payment Reform: Emerging State and Regional Innovation. Katherine Hempstead, Jon Christianson, Douglas Conrad, David Grembowski, Dennis Scanlon.

American Public Health Association Annual Meeting presentation, November 2013: Value-based payment reform: cross-cutting lessons from state and regional innovation in the United States. Douglas Conrad, David Grembowski, Miriam Marcus-Smith, Judy Chang, Susan Hernandez, Bernard Lau.

Sites

AF4Q Payment Reform
Maine Health Management Coalition Foundation (Maine)
Project Period: 01/2010 - 01/2013

Piloting Population-Based Health Metrics for ACOs
Maine Health Management Coalition Foundation (Maine)
Project Period: 05/2011 - 05/2013

Development & Implementation of Payment Reform to Pay Equally for What Works Equally Well
Massachusetts General Hospital (Massachusetts)
Project Period: 05/2011 - 05/2012

Accountability through Transparency and Informed Design
University of New Hampshire (New Hampshire)
Project Period: 05/2011 - 05/2013

Implementing Primary Care Reform in Oregon: A Coordinated Community-Wide Approach
Quality Corp (Oregon)
Project Period: 01/2010 - 01/2013

Program Oriented Payment (POP) Demonstration Project
Physicians Choice Foundation (Oregon)
Project Period: 05/2011 - 05/2012

Novel Provider Payment
Pittsburgh Regional Health Initiative (Pennsylvania)
Project Period: 05/2011 - 05/2014

Washington State Multi-Payer Medical Home Reimbursement Pilot
Puget Sound Health Alliance (Washington)
Project Period: 10/2010 - 01/2012

Site Reports

Access the full Report and the Executive Summary for each site.

For additional information about the Robert Wood Johnson Foundation's support of this topic, visit its Health Care Payment Reform page.

Maine

Massachusetts

New Hampshire

Oregon (Quality Corp, Portland)

Oregon (Physicians Choice Foundation, Salem)

Pennsylvania

Washington

Advisory Group

Robert A. Berenson, MD
Institute Fellow
The Urban Institute

Suzanne Delbanco, PhD
Executive Director
Catalyst for Payment Reform

R. Adams Dudley, MD, MBA
Professor of Medicine and Health Policy
University of California San Francisco

Meredith Mathews, MD, MPH
Former Chief Medical Officer
Blue Shield of California

Hector Rodriguez, PhD, MPH
Associate Professor, Health Services
University of California Los Angeles

Stephen Schoenbaum, MD, MPH
Special Advisor to the President
The Josiah Macy Jr. Foundation

Cindy Watts, PhD
Professor and Chair, Department of Health Administration
Virginia Commonwealth University

Gary Young, JD, PhD
Director, Center for Health Policy and Healthcare Research
Northeastern University

Contacts

Principal Investigator: Douglas Conrad, PhD
dconrad@uw.edu

Co-Investigator: David Grembowski, PhD
grem@uw.edu

Project Manager: Miriam Marcus-Smith, RN, MHA

Research Assistant: Susan Hernandez, MPA