Ten Barriers to Healthcare Payment Reform and How to Overcome Them

The following report was written by Harold Miller, CEO of the Network for Regional Healthcare Improvement (NRHI), for the Center for Healthcare Policy and Payment Reform (CHQPR).  The report describes some of the biggest barriers that clinicians, hospitals, health plans, employers, and policy-makers face in implementing payment reforms, and includes strategies for solving them.

Here’s an example of the kind of information you can expect to find in this report:

  • How “shared savings” payment models can actually be a barrier to significant changes in care delivery because they make no real changes to the fee-for service system, and how only true payment reforms, such as episode-of-care payments, condition-specific comprehensive care payments, and global payments can allow win-win-win approaches for providers, payers, and patients.
  • The ways that payment systems can be structured to give providers accountability for the types of services and costs they can control, but protect them from risks associated with costs they cannot control.
  • Why payment reforms and Accountable Care Organizations are unlikely to be successful unless physician compensation systems are also changed to reward value instead of volume.
  • Why lack of access to data on utilization and costs can prevent healthcare providers from offering to deliver care in ways that will save money for employers, Medicaid, Medicare, and health plans, and how data and analysis can be made available to support successful payment reform.
  • The ways that health plan benefit designs as well as payment systems need to be changed so that patients have the ability and incentive to work with physicians and other healthcare providers to improve quality and reduce costs.
  • The need for more comprehensive, outcome-based measures of quality to accompany payment systems that are designed to control costs.
  • The importance of having all payers using common approaches to payment reform, and the specific strategies that can be used to encourage and facilitate alignment of payment systems in a community.
  • The unique challenges hospitals will face as part of efforts to reduce costs, and the kinds of actions both hospitals and payers can take to address those challenges.
  • How regulatory, accreditation, and payment policies favor large provider organizations in ways that can lead to higher costs, and the policy changes that are needed to foster more effective competition among providers.
  • The need for community mechanisms to ensure there is coordinated action in all of these areas, and the important role that Regional Health Improvement Collaboratives can play in supporting implementation of needed payment and delivery reforms.

Download the Report