Health Care Quality Gets Boost From Value-Based Payment Commitments

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Health care quality took two giant leaps forward this week with parallel commitments by government and the private sector toward firm goals for value-based payment.

United States Department of Health and Human Services Secretary Sylvia Burwell announced on January 26 that Medicare intends to have 30 percent of Medicare fees paid in alternative payment models by 2016 and 50 percent by 2018.

Two days later, a broad coalition of 16 leading health care systems and organizations, four major insurers as well as purchasers and consumer advocates announced its goal of having 75 percent of payments be value-based by 2020.

Medicare, our nation’s largest and arguably most influential insurer, has been moving toward paying for value instead of volume for some time now. So have many private and other public sector insurers, with strong support from employers, other payers and advocates. However, establishment of these firm goals will help us to much more clearly measure and track our progress against these targets and timelines. That is critical, as you cannot improve what you do not measure.

These stunning commitments are a testament to the enormous progress made by all our colleagues who have been working so hard to improve the quality and value of health care with measurement, transparency and accountability. As we announced earlier this year, the majority of Americans – over 171 million– are now in plans that report NCQA’s HEDIS (Healthcare Effectiveness Data and Information Set) clinical quality measures, which are essential for providing needed feedback to alternative payment models.

The fact that measurement and accountability are now baked into the DNA of our entire health care system, resulting in both better quality and bending of the cost curve to historically low levels, make these goals and timelines both sensible and broadly acceptable to virtually all stakeholders.

We, of course, can and must do much more to meet these goals and fully transform our health care system to reward value. But these parallel announcements mark an extraordinarily significant milestone in our shared journey.

Margaret E. O'Kane
Margaret E. O’Kane is the founding and current president of NCQA. Modern Healthcare magazine has named O’Kane one of the “100 Most Influential People in Healthcare” nine times, most recently in 2014, and one of the “Top 25 Women in Healthcare” three times.

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