Focusing on Healthcare Care Quality and Management with Pay for Value (P4V)

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Emphasizing improved health, quality of care, patient experience, and overall efficiency, the Delaware Center for Health Innovation (DCHI) is actively moving the consumer healthcare experience towards an outcome-based payment model.  By 2020, DCHI hopes to have more than 95% of healthcare spending falling within either a Pay for Value (P4V) program or a Total Cost of Care (TCC) program.

So what does this mean for payers, providers and consumers?  Specifically for the P4V program, payers will offer primary care providers the opportunity to earn bonus payments based on performance as judged by a combination of both quality and efficiency targets (e.g. frequency of readmissions and emergency department visits). These 26 targets are outlined in the Common Scorecard established by DCHI, and include metrics for both direct patient care and provider collaboration with the broader healthcare system in Delaware. In 2016, DCHI’s Payment Model Monitoring Committee secured commitments from major commercial and Medicaid payers to adopt alternative payment models for primary care to align more than 75% with Common Scorecard measures.  In addition, down the road, DCHI hopes to incorporate measures of the consumer experience into the P4V model. P4V will ultimately incentivize both the quality and management of consumer healthcare, leading to a more positive and engaged patient experience.

Both the P4V and TCC programs are built on current models and are designed to support the broader delivery system transformation already underway, including population health improvements and behavioral health access.  With P4V, DCHI allows any provider to enter into the outcomes-based payment system no matter their size, scale, or financial resources.  While many ACOs or CINs have the capacity to move into a TCC model immediately, there are still a large number of providers who operate independently and need the time and room to scale up to the TCC program. P4V provides an opportunity to ease into an outcome-based payment model. DCHI encourages all payers to offer at least one P4V program and at least one TCC program for providers to ensure all can begin moving towards this reimbursement approach.

A more detailed breakdown of DCHI’s recommendations to payers to ensure the adoption and use of P4V and TCC programs can be found in the DCHI white paper Outcomes-Based Payment for Population Health Management.

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