Innovative approaches to lowering costs and improving outcomes
|John W. Rowe, M.D.
Helen Darling, M.A.
National Business Group on Health
Demanding Value from our Health Care: Motivating Patient Action to Reduce Waste in Health Care
From Pilots to Practice: Speeding the Movement of Successful Pilots to Effective Practice
Issue. Health care in the United States is, in many circumstances, the best in the world. Yet we pay more for health care relative to other nations to get results that, on a population basis, are just mediocre. How can we “bend the curve?” The prevailing approach to payment for health care—which focuses predominantly on fees for individual service units delivered—lies at the center of the issue. From a purely economic perspective, the current incentive is to provide more services, independent of the value added. Although there is general agreement on the need to find better ways of redirecting the incentives away from volume and toward value, little established information exists on the most effective approaches to truly reward outcomes or value. Some promising initiatives are developing—e.g. value-based payment design, pay for performance, bundled payments, and non-payment for “never events.” However, more attention to innovation, testing, and demonstrated impact is still needed. From 2008-2009, the IOM Roundtable on Value & Science-Driven Health Care, with substantial support from the Peter G. Peterson Foundation, convened a series of five meetings to explore in detail the key issues and opportunities in improving outcomes and reducing costs. The first workshop, Value in Healthcare: Accounting for Cost, Quality, Safety, Outcomes and Innovation, placed an initial focus on approaches to understanding, measuring, and improving value. This was followed in 2009 with the four-part workshop series, The Healthcare Imperative: Lowering Costs, Improving Outcomes, aimed at exploring the challenge: “How can healthcare costs be reduced in 10 years, without compromising outcomes, safety, or valued innovation?” These meetings systematically identified and assessed—both qualitatively and quantitatively— the sources of excess cost in health care, insights already developed on approaches to reducing waste, and priority policy issues and options.
Collaborative. An ad hoc convening activity, under the auspices of the IOM Roundtable, the Value Incentives Learning Collaborative (VILC) seeks to build on the foundation of prior work engaged by the Roundtable to develop a learning network by convening organizations and individuals actively working to design, develop, test, and evaluate innovative approaches to shifting health care payment in ways that reward value.
Participants. VILC participants represent organizations and individuals devoted to value determination in health care, and to the implementation of innovative payment approaches that provide incentives according to the value delivered. The aim is for an inclusive Collaborative—without walls—and participation in individual projects is structured according to interest, need, and practicality.
Activities. Projects completed, under way, or under consideration by VILC:
Identification and assessment of incentive misalignment in health care. The Collaborative is identifying prominent examples of the ways economic incentives in health care might be misaligned, and exploring alternative approaches.
Value incentive project inventory and taxonomy. VILC is gathering examples of value-focused innovation initiatives to improve the understanding of the state of play, enhance prospects for collaboration, and inform work on lessons for future implementation. From these examples, they plan to create a taxonomy of value incentives to provide an analytical framework for identifying and considering different value initiatives.
Patient and provider engagement in value initiatives. The Collaborative is exploring ways to engage patients in value initiatives— such as through incentives for increased transparency, health education, and health promotion—by surveying and analyzing existing value initiatives and transparency programs, with a focus on ensuring that patients have the supports and tools they need to find and access high-value care.
February 19, 2013
June 15, 2012
October 14, 2011
October 4, 2011
June 15, 2011
Visit our new page on the NAM website