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Value-Based Purchasing in Health Care

Journal Article
CalAIM and Specialty Behavioral Health Care: Lessons from Other States on Value-Based Payment
This report examines the experience of state Medicaid agencies with implementation of value-based payment models for behavioral health care and the implications of that experience for future payment reform in California.
May 5, 2023
Journal Article
Evaluation of Phase II of the Medicare Advantage Value-Based Insurance Design Model Test: First Two Years of Implementation (2020–2021), and Appendixes
This report presents the RAND Corporation team's findings from its evaluation of Phase II of the Medicare Advantage Value-Based Insurance Design model test, for the years 2020 and 2021.
Oct 19, 2022
Journal Article
Physician Compensation Arrangements and Financial Performance Incentives in US Health Systems
This study was a cross-sectional mixed-methods analysis of in-depth multimodal data from 31 POs affiliated with 22 purposefully selected health systems in 4 states. Data were analyzed from June 2019 to September 2020.
Feb 8, 2022
Journal Article
Value-Based Payment and Health Care System Preparedness and Resilience
This report explores issues related to VBP and health system preparedness and resiliency to inform discussions about policy options for jointly promoting value, efficiency, and preparedness in the health care system.
Oct 7, 2021
News Release
Low-Value Care Among Medicare Recipients Drops Only Marginally Despite Effort to Curb Practices
Examples of low-value health care include prescribing opioids for acute back pain and antibiotics for upper respiratory infections. Despite efforts to better educate clinicians and discourage wasteful care, spending on such services among Medicare recipients dropped only marginally from 2014 to 2018.
Feb 16, 2021
Journal Article
Anesthesiologists and the Transformation of the Healthcare System: A Call to Action
This is the second in a series of six editorials on the changing definitions of safety across the perioperative period and how anesthesiologists can participate in and lead the transformation of health care with focus on patient value.
Dec 18, 2020
Journal Article
How Are Medical Groups Identified as High Performing? The Effect of Different Approaches to Classification of Performance
To accurately identify "high-performing providers", a standard definition of high-performance and an agreed-upon approach to measurement are necessary.
Jul 24, 2019
Journal Article
What Defines a High-Performing Health System: A Systematic Review
Lack of a consistent definition of a high-performing health system severely hampers our ability to compare delivery systems based on performance.
Aug 15, 2017
Journal Article
Association Between Hospitals' Engagement in Value-Based Reforms and Readmission Reduction in the Hospital Readmission Reduction Program
Hospitals participating in one or more voluntary Medicare value-based reform programs were less likely to readmit patients within 30 days of discharge than non-participating hospitals.
May 23, 2017
Journal Article
Understanding the Role Played by Medicare's Patient Experience Points System in Hospital Reimbursement
Patient experience points related to improvement and consistency have a small but important effect on payments to hospitals serving large proportions of disadvantaged patients under the Medicare Hospital Value-Based Purchasing program.
Sep 15, 2016
Journal Article
How Can We Improve the Efficiency of Specialty Care?
Four strategies could be helpful in determining the "right" number of specialty care visits--and reducing unnecessary spending.
Jul 19, 2016
Report
Introducing Value-Based Purchasing into TRICARE Reform
Congress is considering how to update TRICARE, the U.S. Department of Defense health benefits program. In this Perspective, the authors evaluate two existing proposals that incorporate value-based purchasing and describe a hybrid alternative.
Apr 19, 2016
Report
Medical Device Innovation in the Era of the Affordable Care Act
Changing incentives in the health care sector and the move to value-based payment models will force device manufacturers to redirect investments from the spectacular toward the prudent—lower cost, less sexy.
Feb 8, 2016
News Release
Medical Home Intervention with Shared Savings Shows Quality and Utilization Improvements
A medical home intervention that paid bonuses to physician practices based on financial savings showed significant improvements in quality and use of some medical services relative to comparison practices.
Jun 1, 2015
Blog
Five Years of the Affordable Care Act
The Affordable Care Act has officially been part of the U.S. health care landscape for five years. We reflect on the twists and turns that followed its passage and the RAND research that informed debates along the way, and look ahead to the future of the ACA.
Mar 23, 2015
News Release
Promise of Value-Based Purchasing in Health Care Remains to Be Demonstrated
After a decade of experimentation with reforms that give health providers financial incentives to improve performance, relatively little is known about how to best execute such strategies or judge their success.
Mar 4, 2014
Report
Measuring Success in Health Care Value-Based Purchasing Programs: Summary and Recommendations
Reviews what has been learned over the past decade about performance-based payment strategies in health care and offers recommendations for the design, implementation, and monitoring and evaluation of value-based purchasing programs.
Mar 4, 2014
Report
Promise of Value-Based Purchasing in Health Care Remains to Be Demonstrated
After a decade of experimentation with reforms that give health providers financial incentives to improve performance, relatively little is known about how to best execute such strategies or judge their success.
Mar 4, 2014
Testimony
Efforts to Reform Physician Payment by Tying Payment to Performance
Public and private sector purchasers are actively working to design value-based payment programs to achieve the goals of improved quality and more efficient use of health care resources. How these programs are designed is a complex undertaking and one that will determine the likelihood of their success.
Feb 14, 2013
Journal Article
How Well Do Medicare's Pay-for-Performance (P4P) Programs Match Desirable P4P Design Criteria?
Alignment with best P4P practices varies across Medicare programs; the program for Medicare Advantage aligns most strongly. It is unclear which P4P design elements are critical for quality improvement. Unintended consequences of design features are poorly understood.
Jan 1, 2013

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Researcher Spotlight

Susan L. Lovejoy

Senior Policy Analyst

Susan Lovejoy is a senior policy analyst at the RAND Corporation. She provides qualitative research support and project management across a wide range of subjects, such as provider performance measurement, value-based purchasing in Medicare and the private sector, Medicare physician payment,…
Kanaka Shetty

Physician Policy Researcher

Kanaka Shetty is a physician policy researcher at the RAND Corporation. He is also an affiliate faculty member at the Pardee RAND Graduate School and a practicing hospital-based internist. His current research assesses quality measurement programs with a focus on provider impact as well as…

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