May 21 2010
As a nation we spend nearly $7,300 per person on health care each year - but are we getting the best possible value for our dollars? Exploring promising innovative approaches to getting high quality from health care purchases while ensuring that our annual $2.3 trillion in public and private health care spending is going as far as it should - in terms of top quality care, improved health outcomes and minimal waste - will be part of new work undertaken by the Engelberg Center for Health Care Reform at Brookings and supported by the Aetna Foundation.
"In our health care system, employers and taxpayers are the primary purchasers of health care services, and as health care costs continue to escalate, more and more purchasers are looking to understand how they can get real value from their health care investments," said Ronald A. Williams, chairman of the Aetna Foundation.
In payment arrangements based on value, providers of health care are held accountable for both the cost and quality of the care delivered - enabling them to receive more financial support for steps that improve care and lower costs, but that are not reimbursed in traditional provider payment systems. This is accomplished by examining both quality data, including patient outcomes and health status, as well as cost data. Participants in these arrangements manage the use of health care services to reduce inappropriate care and identify and reward the best-performing, high quality providers. Medicare, along with a number of employer-based insurers, is working to become a value-based purchaser of health care services. As an example, Medicare is testing payments for "medical home" services, and it initiated a program in 2008 to no longer pay hospitals for the cost of care associated with preventable hospital-based infections, mistakes, or injuries.
"This grant supports exploration into a range of effective approaches for implementing and evaluating value-based purchasing programs, as well as dissemination of the results of that work so that all health care purchasers - from private employers to the federal government - can take advantage of the learnings and conclusions," said Anne C. Beal, MD, MPH, president of the Aetna Foundation.
The $331,133 grant will support the "Advancing Value-Based Purchasing in the U.S. Health System" project, which will run through April 2011. The project will convene experts to recommend strategic approaches to value-based purchasing and share those recommendations with key stakeholders. The goal is to develop an implementation approach that will improve quality and reduce costs system-wide through the close collaboration of public- and private-sector stakeholders. As such, the project aligns with legislative mandates such as the creation of a Center for Medicare and Medicaid Innovation and supports efforts to rethink how to expedite the broad execution, evaluation, and dissemination of these value-based purchasing strategies in both the public and private sectors.
"The fragmentation and silos in our health care system complicate efforts to improve overall health system performance for patients. The new legislation provides unique opportunities for Medicare to participate in public-private collaborations in payment reforms that provide better support for high-value care, which will be critical to bending the cost curve and improving quality. We're pleased that the Aetna Foundation is supporting this effort to provide important insights at a pivotal time for health care reform implementation," said Mark McClellan, director of the Engelberg Center for Health Care Reform and Leonard D. Schaeffer Chair in Health Policy Studies at the Brookings Institution.
The value-based purchasing project is one of a number of initiatives underway at the Engelberg Center, which focuses on developing data-driven, practical policy solutions that promote broad access to high-quality, affordable, and innovative care in the United States.
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