• J Palliat Med · Mar 2018

    Review

    Linking Quality and Spending to Measure Value for People with Serious Illness.

    • Andrew M Ryan and Phillip E Rodgers.
    • 1 Department of Health Management and Policy, University of Michigan School of Public Health , Ann Arbor, Michigan.
    • J Palliat Med. 2018 Mar 1; 21 (S2): S74-S80.

    BackgroundHealthcare payment is rapidly evolving to reward value by measuring and paying for quality and spending performance. Rewarding value for the care of seriously ill patients presents unique challenges.ObjectiveTo evaluate the state of current efforts to measure and reward value for the care of seriously ill patients.DesignWe performed a PubMed search of articles related to (1) measures of spending for people with serious illness and (2) linking spending and quality measures and rewarding performance for the care of people with serious illness. We limited our search to U.S.-based studies published in English between January 1, 1960, and March 31, 2017. We supplemented this search by identifying public programs and other known initiatives that linked quality and spending for the seriously ill and extracted key program elements.ResultsOur search related to linking spending and quality measures and rewarding performance for the care of people with serious illness yielded 277 articles. We identified three current public programs that currently link measures of quality and spending-or are likely to within the next few years-the Oncology Care Model; the Comprehensive End-Stage Renal Disease Model; and Home Health Value-Based Purchasing. Models that link quality and spending consist of four core components: (1) measuring quality, (2) measuring spending, (3) the payment adjustment model, and (4) the linking/incentive model. We found that current efforts to reward value for seriously ill patients are targeted for specific patient populations, do not broadly encourage the use of palliative care, and have not closely aligned quality and spending measures related to palliative care.ConclusionsWe develop recommendations for policymakers and stakeholders about how measures of spending and quality can be balanced in value-based payment programs.

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