Center for Healthcare Quality and Payment Reform Information

The Center for Healthcare Quality and Payment Reform was established in 2008 with funding from the Jewish Healthcare Foundation to encourage comprehensive, outcome-driven, regionally-grounded approaches to achieving higher-value healthcare. The Center's strategic approach is unique in the following ways:Fundamental Payment Reform Instead of P4P.A huge national infrastructure has been developed over the past several years to administer modest pay-for-performance (P4P) incentive systems on top of the existing payment structure. Although well-intentioned, this has added new administrative costs without eliminating any existing costs or eliminating the counterproductive incentives in fee-for-service payment, and has the potential for stifling outcome-driven quality improvement by rigidifying currently accepted processes. The Center for Healthcare Quality and Payment Reform focuses on truly fundamental payment reforms, such as episode-of-care payment and condition-specific capitation, that focus on improvements in outcomes, rather than merely process measures. Payment Reform as a Means to Better Value, Rather Than an End in Itself. Too often, payment reforms of all types are discussed as ends in themselves, rather as means to enable and encourage specific changes in care delivery. For example, P4P systems are designed to provide additional payments as incentives for healthcare providers to deliver better quality-care, when the problem in many cases is not a lack of willingness by the providers, but a lack of ability to redirect current payments in ways that will result in better-quality care. Even where care changes and payment changes are discussed jointly, as in efforts to implement the patient-centered medical home, proposals tend to add new layers of payment, while leaving existing incentives in place, and to focus on processes, rather than outcomes. The Center for Healthcare Quality and Payment Reform focuses on defining comprehensive, outcome-driven solutions including not only payment changes but also the care delivery changes they will support. Bottom-Up Rather than Top-Down Reform. Healthcare is delivered at the local level and is paid for primarily at the local or regional level. Regions of the country differ dramatically in the structure of provider organizations and payment systems, so it is unlikely that there will be any one-size-fits-all structure that will work effectively, at least in the short run. The Center for Healthcare Quality and Payment Reform focuses on how to design payment and care delivery reforms based on the unique assets and barriers which exist in individual regions, and with the active input and involvement of the actual providers, payers, purchasers, and patients who will need to implement them. Pragmatic Pathways to Reform. Relatively few healthcare providers have the organizational structure or skills in quality improvement or process redesign to immediately accept new payment structures. Since current healthcare payment systems primarily reward volume, not quality or efficiency, it is likely that skills in designing and managing care processes to improve quality and control costs will be in short supply until the incentives change. Consequently, the Center for Healthcare Quality and Payment Reform not only works to define the ultimate structures for payment reform and improved delivery, but also to design transitional improvements to both payment systems and organizational structures that will facilitate the transition to those ultimate structures - a "co-evolution" of payment and organizational capacity.