From volume to value: better ways to pay for health care.

Payment systems for health care today are based on rewarding volume, not value for the money spent. Two proposed methods of payment, "episode-of-care payment" and "comprehensive care payment" (condition-adjusted capitation), could facilitate higher quality and lower cost by avoiding the problems of both fee-for-service payment and traditional capitation. The most appropriate payment systems for different types of patient conditions and some methods of addressing design and implementation issues are discussed. Although the new payment systems are desirable, many providers are not organized to accept or use them, so transitional approaches such as "virtual bundling," described in this paper, will be needed.

[1]  James N Weinstein,et al.  Trends and geographic variations in major surgery for degenerative diseases of the hip, knee, and spine. , 2004, Health affairs.

[2]  J. Christianson,et al.  Evolution in the Buyers Health Care Action Group purchasing initiative. , 2002, Health affairs.

[3]  James C. Robinson,et al.  Theory and practice in the design of physician payment incentives. , 2001, The Milbank quarterly.

[4]  Johnson Ll.  An alternative health-care reimbursement system. , 1994 .

[5]  Richard F. Averill,et al.  Clinical Risk Groups (CRGs): A Classification System for Risk-Adjusted Capitation-Based Payment and Health Care Management , 2004, Medical care.

[6]  Charles N Kahn.  Payment reform alone will not transform health care delivery. , 2009, Health affairs.

[7]  G. Hallman,et al.  CardioVascular Care Providers. A pioneer in bundled services, shared risk, and single payment. , 1995, Texas Heart Institute journal.

[8]  B. Starfield,et al.  Prevalence, expenditures, and complications of multiple chronic conditions in the elderly. , 2002, Archives of internal medicine.

[9]  Elliott S Fisher,et al.  Geography and the debate over Medicare reform. , 2002, Health affairs.

[10]  L. Leape,et al.  Racial Differences in Cardiac Revascularization Rates: Does Overuse Explain Higher Rates among White Patients? , 2001, Annals of Internal Medicine.

[11]  H. Tu,et al.  Self-pay markets in health care: consumer Nirvana or caveat emptor? , 2007, Health affairs.

[12]  L. Kozak,et al.  Trends in avoidable hospitalizations, 1980-1998. , 2001, Health affairs.

[13]  Armen H. Thoumaian,et al.  Cost Savings and Physician Responses to Global Bundled Payments for Medicare Heart Bypass Surgery , 1997, Health care financing review.

[14]  Allan H. Goroll,et al.  Fundamental Reform of Payment for Adult Primary Care: Comprehensive Payment for Comprehensive Care , 2007, Journal of General Internal Medicine.

[15]  R. Murray.  Setting hospital rates to control costs and boost quality: the Maryland experience. , 2009, Health affairs.

[16]  Stephen M. Shortell,et al.  Health care reform requires accountable care systems. , 2008, JAMA.