“This agreement offers the basis for crafting the next steps in reform,” the authors wrote. They said there is consensus around value-based payments and insurance design.
The proposals call for “shifting from fee-for-service reimbursement for clinicians and hospitals to incentives for improved care quality, patient satisfaction and measured outcomes,” the authors wrote. All proposals reviewed also call for insurance incentives that will encourage patients to make healthier choices and seek high-quality care.
That consensus is “very striking, very encouraging,” said Paul Ginsburg, president of the Center for Studying Health System Change. Ginsburg, a health economist, has reviewed five of the proposals and five others in work for the Robert Wood Johnson Foundation. “They're all talking about changes in the way that healthcare is delivered that would reduce the role of fee-for-service payments” in favor of bundled payments, medical homes or accountable care.
But few “get beyond vision,” he said. The Bipartisan Policy Center included plans that would add “muscle” to policies that break from fee-for-service, Ginsburg said.
The Brookings Institution also made more concrete proposals, which the authors said could reduce federal healthcare spending by $300 billion over a decade.
The Patient Protection and Affordable Care Act, several states and some private market initiatives are testing models that seek to develop more value-based financing and delivery models, including accountable care organizations, though Medicare's test of accountable care continues to rely on fee-for-service and offers an additional financial incentive to try to curb costs.
The authors acknowledged the challenge that any healthcare reform will face—and how little is currently known about what models might be most successful. “Despite its substantial achievements, healthcare in the United States remains woefully complex and inefficient, and treading the elusive path toward sustainability will not be easy,” they said. “In addition, there are few data to support many of the recommendations.”
Other policy proposals received less consensus than value-based financing and insurance. Global spending targets, a policy recently adopted by Massachusetts, won the least support, with endorsement by the Bipartisan Policy Center and the Brookings Institution.