Multi-modal approaches are needed to reduce healthcare costs and promote a better quality of care
Because there are different modes of achieving health care quality, there should be a closer look at designing payments towards clinicians or health care organizations based on measures of quality. This is the Value-based payment. Value-Based Payment (VBP) is a concept by which purchasers of health care (government, employers, and consumers) and payers (public and private) hold the health care delivery system at large (physicians and other providers, hospitals, etc.) accountable for both quality and cost of care (“Value-Based Payment”, n.d.)
The adoption of a value-based payments system and the strengthening of accountable care organizations are concrete examples of innovation.
Price transparency is another innovation that should also be lauded. As an ideal model, the Centers for Medicare and Medicaid Services should collaborate with private insurers so that both can evaluate new payment models.
In fact, effective on January 1, 2021, the Price Transparency Rule (the “Rule”) requires all hospitals operating within the United States to make public a list of their standard charges for items and services via the Internet in a machine-readable format. (Weatherford et al., 2020) This is the starting point!
Price transparency is set to “improve access to, and the quality of, information that Americans need to make informed health care decisions, including data about health care prices and outcomes, while minimizing reporting burdens on affected plans, health care providers, or payers.” (Reed, 2019)
The benefit for the community, including my family, is that the secretly negotiated prices charged by insurance companies for services will be known and that will drive the actual cost of care down.
Reed, R. (2019). Costs and Benefits: Price Transparency in Health Care. Healthfinancejournal.com
The Complex Relationship between Cost and Quality in US Health Care. (2014), 16 (2), 124–130.
Value-Based Payment. Aafp.org.
Weatherford, E., Gadani, V., & Smith, S. (2020). The Price Transparency Rule Goes Into Effect January 1, 2021–Is Your Hospital Ready? | Healthcare Law Insights. Healthcare Law Insights.t.