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.
NRHI’s Payment Reform Resources
- 2016 National Payment Reform Summit Final Summary Report: Accelerating the Implementation of Value-Based Care and Payment
- The Building Blocks of Successful Payment Reform: Designing Payment Systems that Support Higher–Value Health Care;
- Moving from Quality to Value: Measuring and Controlling the Cost of Health Care
- Advancing Transparency to Reform Payment: The Top Dos and Don’ts from Regional Multi-Stakeholder Collaboratives.
- The Best Antidote to Provider Market Power is to Change the Healthcare Payment System
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 Role of RHICs
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 35 Regional Health Improvement Collaboratives in the US. All of the leading Collaboratives are members of NRHI, providing programs to support improved healthcare for over 40 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.