How Do We Create Better, More Affordable Healthcare?

Communities across the U.S. need to create ways to measure and control costs, and measure and improve quality, so that high-value healthcare can be delivered and rewarded/recognized. However, the lack of transparency around cost of care information has impeded the acceleration of meaningful payment reform.  Regional, multi-payer, multi-stakeholder collaboratives, known as Regional Health Improvement Collaboratives or RHICs, are also addressing these issues. The NRHI Brief, Complementary Roles of State and Regional Health Improvement Collaboratives in Supporting Payment and Delivery System Transformation,  describes the different strengths and capabilities of state governments and RHICs in advancing delivery system and payment reform. It describes ways that states and RHICs can work together in the incredibly complex and competitive payment reform environment to create “win-win” approaches. It provides examples from around the country where state agencies and RHICs are working together for mutual benefit.

Recommended Reading:

NRHI’s Payment Reform Series:

NRHI has a long history of producing groundbreaking work on payment reform and below are additional resources to learn about payment reform:


The Need for Transparency

Transparency is essential for transforming our healthcare system to prioritize patient health and reward value, rather than volume, of healthcare services provided. Meaningful information about cost, quality and patient experience is needed for consumers, private and public purchasers and health insurers to make smart decisions about healthcare, including designing benefits and payment models that reward appropriate and effective care. For example, employers and payers need meaningful information to evaluate physicians, clinics, facilities and ACOs for inclusion in their networks, to route patients with specific needs to care that will be effective for them and to design benefits that encourages their beneficiaries or members to make choices that lead to better health at a lower cost.

The Center for Healthcare Transparency, a non-profit led by NRHI and the Pacific Business Group on Health, is laying the groundwork for greater transparency and potential to transform our healthcare system by making information on the relative cost and quality of healthcare services consistently and easily available for 50% of the US population by 2020. The Center is currently in the planning phases of implementing a network of regionally governed multi-stakeholder data entities that are capable of bringing rich clinical and patient experience data together with cost and other claims data from all payers in a given market and that also have the local relationships to ensure that information drives improvement. User needs are determining what participants in the Center for Healthcare Transparency will produce. For example: purchasers seeking to develop global contracts or value based benefit design may require cost and utilization information, patients seeking to choose where to receive care may require outcomes information at the provider, practice and facility levels. An Executive Committee which includes leading thinkers from regional health improvement collaboratives, purchasers, providers, health plans and the U.S. Department of Health and Human Services is overseeing the Center for Healthcare Transparency.

 

The Need for Total Cost of Care

Neither utilization nor price alone is adequate for understanding the reasons why healthcare costs are increasing or why they are higher in one community than another, nor is it adequate to focus simply on specific types of services. A more comprehensive approach – looking at the total cost of care – is essential. If the total cost of care in a community is lower than in others, and the quality of that care is equal or better (or if the quality is higher and the cost is the same), then the residents of that community know they are getting higher-value care. Similarly, if the total cost of care delivered by a healthcare practice or individual provider is lower than what is delivered by another practice or provider, and the quality is higher, then a patient choosing that provider will know they are getting truly higher-value care, as opposed to not high-quality, but unaffordable care, nor low-cost, but low-quality care. Learn about NRHI’s Total Cost of Care Pilot. 

 The Need for Multi-Stakeholder Collaboratives

Improving health, improving quality and reducing costs has to happen at the local level with the purchasers and providers of care working together to design a system that works. Here are the basics:

  • Providers need to change the way they deliver care
  • Payment and benefit systems need to support and reward higher-value care
  • Patients need to know the cost and quality of their healthcare and be engaged in managing their health

There are many specific and complex tasks within each function. All of these changes need to be coordinated, but how can this happen in a coordinated way? It starts with a common, neutral table for all stakeholders and reliable and transparent data to inform improvement.
What is a Regional Health Improvement Collaborative (RHIC)? Download this white paper to learn more.

RHICs do not provide healthcare or pay for healthcare. They convene those who do – and the people and the communities they serve – to identify ways to catalyze change for better outcomes and lower cost.

Collaboratives establish their direction through consensus among their members. No one can fix the healthcare system alone – it will require change from providers, purchasers, and communities. Through this unique collaboration, these stakeholders are able to tackle compelling health challenges together.

There are over 40 Regional Health Improvement Collaboratives in the US. All of the leading Collaboratives are members of NRHI, providing programs to support improved healthcare for over 35 percent of the US population. These Collaboratives have demonstrated a unique ability to work with providers and other community stakeholders to measure and improve quality and reduce costs in their states and regions.

Recommended Reading: